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  • If you're pale skinned what does hyperpigmentation look like?

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    Old 08-08-2006, 07:10 AM   #1
    Racheldee
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    Question If you're pale skinned what does hyperpigmentation look like?

    Hi

    I'm not dx'd with Addisons but from all the info I've read, I feel that I have some kind of adrenal problem. I just wondered what hyperpigmentation would look like on someone with very pale skin. I've noticed some changes on my skin recently - my inner arm bend (where you have blood from - sorry I'm sure there's a technical name for it) has developed a pale brownish dirty looking patch (both arms), the skin just below where your nails start has a brownish tinge on all fingers and quite noticeably on both big toes, and on my face just below the corners of my mouth on both sides there's a dirty looking area. I don't sit out in the sun at all and I'm very pale skinned.

    Is hyperpigmentation normally more noticeable than this?

    Thanks

     
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    Old 08-08-2006, 09:25 PM   #2
    WandaB
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    Re: If you're pale skinned what does hyperpigmentation look like?

    Hyperpigmentation would be different with each person or not there at all. Anything in your mouth? Are you feeling sick? Seems you have good reason to have the ACTH stimulation test along with the Electrolytes to check for addisons. Low sodium & high potassium is a sign of addisons. Be sure they do the STIM test properly so it counts.


    Diagnostic Testing for Addison's Disease


    TEST 1: Electrolyte profile:

    OBJECT: To determine if the patient exhibits a normal serum (blood) sodium and potassium levels.

    THE TEST: A blood draw followed by automated determination of sodium and potassium levels as well as other standard blood markers.

    NORMAL RESULT (will vary somewhat from lab to lab): Sodium 135-150 mEq/L; Potassium 3.5-5.2 mEq/L

    PRIMARY ADDISONIAN: Will show significantly below normal values of sodium and a elevated (above normal) levels of potassium.

    REASON FOR ABNORMALITY: Low or no production of aldosterone from the adrenal cortex. This steroidal hormone regulates our mineral balance and is called a mineralocorticoid. Primary Addisonians lose sodium and retain potassium. Abnormal values here, in additon to physical signs and symptoms, require the next test.


    TEST 2: The ACTH stimulation test:

    OBJECT: To determine if the patient's adrenal glands can respond to the ACTH message from the pituitary to increase cortisol production in the adrenal cortex.

    THE TEST: The test is usually given first thing in the morning when normal cortisol levels are highest. Blood is withdrawn from the patient to establish a baseline (No instructions regarding necessity for fasting). The patient is given 250 micrograms (ug) of ACTH (Cortrosyn, Cosyntropin, or Synacthen) by injection in saline at one time. Blood is drawn at 30 minutes and/or 60 minutes and the serum cortisol level is determined.

    NORMAL RESULTS: Normal pre-injection levels of cortisol are 5-25 ug/dL (138-690 nmol/L). The value should double at 30-60 minutes with a minimum of 20 ug/dL (552 nmol/L). PRIMARY ADDISONIAN: There will be no or little increase in cortisol levels upon ACTH injection. Notes: It is stated in several places that a single test of cortisol levels, or even 24 h urinary levels of cortisol and its metabolites, are NOT DIAGNOSTIC! In the normal individual cortisol levels are seen to pulse. Low cortisol production in either the serum or the urine after ACTH stimulation is diagnostic of Addisons disease.

    SECONDARY ADDISONIAN (Pituitary malfunction): Low cortisol production can be seen if the patient has "functional adrenal cortical atrophy" due to prolonged absence of normal ACTH secretion. This type of patient would not show the typical hyper-pigmentation of primary Addisons.

    REASON FOR ABNORMALITY: Due to autoimmune, or other destruction of enzymatic (biocatalytic) machinery of the adrenal gland, there is no response to ACTH and no production of cortisol and other adrenal steroids necessary for life. If this test gives normal results and the patient has other signs and symptoms then one of the following tests is required.

     
    Old 08-09-2006, 02:42 AM   #3
    Racheldee
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    Re: If you're pale skinned what does hyperpigmentation look like?

    Thanks for your reply Wanda

    I don't have any signs in my mouth that I can see but I have noticed that I have some brown colouration on my lower eyelid linings.

    Yes I've been feeling really sick lately. I haven't felt well for the last couple of years - I feel so weak and fatigued - worse in the mornings. I've got Crohn's disease too but that seems to be under control.

    I had to go into hospital about 5 weeks ago with bad stomach pains, vomiting and diarrhoea - thought it was to do with the Crohn's but they decided it was gastroenteritis.

    Thanks for the info on the tests - that's really helpful. I've got a Dr's appointment on the 21st so I'll ask her about getting these tests done.

    Rachel

     
    Old 08-09-2006, 09:38 AM   #4
    WandaB
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    Re: If you're pale skinned what does hyperpigmentation look like?

    Rachael,
    My first trip to emergency was treated as the flu. The second as some virus causing diarrhea. They even gave me antibiotics.

    Best thing is to demand the ACTH stim test. Don't "ask" for it. Perhaps print the info about the test to take with you to the doctor appointment.

    Are you taking or have taken Prednisone for the Crohn's?

    Wanda

     
    Old 08-09-2006, 10:00 AM   #5
    Racheldee
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    Re: If you're pale skinned what does hyperpigmentation look like?

    Hi again Wanda

    I'm not taking Pred at the moment but I have had 3 six week courses in the last couple of years.

    You say you went to the emergency twice - were they both related to Addison's but not diagnosed? If you have a crisis (is that the correct term?), can you get over it without it being treated as a crisis?

    Is it possible that what I had was something to do with an adrenal problem rather than a gastro one? I was put on a drip overnight as I was dehydrated, had a shot of morphine and IV steroids.

    Yes, I will print out the info and take it to my next appointment. This is so frustrating - I thought that when I got the Crohn's diagnosed I would start to feel better but I haven't.

    Thanks again
    Rachel

     
    Old 08-09-2006, 02:35 PM   #6
    WandaB
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    Re: If you're pale skinned what does hyperpigmentation look like?

    I was diagnosed on the 3rd or 4th trip to the ER. Yes, related to addisons. Given the ACTH test by a young doc who must have just finished school. I was lucky he was there. They would have told me I had the flu again or whatever. I was tested for antibodies when I saw an endo & am primary. Addisons/adrenal insufficiency can be brought on by using steriods for other things. I had used high doses of Prednisone a couple times for about a week or so at a time, for a cough I couldn't get rid of after being very sick for a month. I know it was whooping cough & was sure I would die each day. Of course the doc just laughed. Perhaps that illness was the final straw for my adrenals????

    You probably had a crisis. The IV saline solution & steriods would bring you around. I only went 3 or 4 days between my ER visits before getting sick again.

    Are you drinking lots of water & adding salt to food? That could help you feel better. If you are feeling lousy try drinking a cup of bouillon. The salt cube dissolved in hot water. I used to drink it 3 times a day while trying to get my adrenals to function.

    Take care,
    Wanda

     
    Old 08-10-2006, 03:01 PM   #7
    Racheldee
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    Re: If you're pale skinned what does hyperpigmentation look like?

    Wanda - yes I'm drinking lots of water. My skin still seems to be really dry though. I'll try the boullion and see if that helps. I've felt really sick today.

    Another question I wanted ask - what sort of stomach aches are related to Addisons. Obvioulsy as I have Crohn's I get a lot of stomach aches but the ones I've had recently seem different.

    With Addison's, is it normal to feel not so bad some days and worse others? Some days I feel really sick and weak and other days I don't feel as bad. I went to the shops yesterday with my son and I had to keep stopping because my legs felt so weak. Today they feel like I spent a couple of hours at the gym.

    I'm glad you finally got a diagnosis.

    Best wishes
    Rachel

     
    Old 08-11-2006, 09:04 AM   #8
    WandaB
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    Re: If you're pale skinned what does hyperpigmentation look like?

    Rachel,

    From what I have read the adrenals can work better on some days than on others with people have problems. You really need the ACTH stimulation test before you have a real crisis.

    If my legs are very painful it is a sign of being low on replacement med. I use Hydrocortisone.

    How is your thyroid? Dry skin can be a sign of a problem with it. Are you losing hair? You would not want to start thyroid treatment before being sure you don't have addisons or being diagnosed & on replacement.

    Until you find out what is going on you need to be very careful. Be sure those around you know you may have a problem & could need IV saline solution if you have a crisis event.

    Take care,
    Wanda

     
    Old 08-11-2006, 09:11 AM   #9
    WandaB
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    Re: If you're pale skinned what does hyperpigmentation look like?

    I forgot to comment on the stomach. Before being diagnosed I would get sick as if it was the flu & vomit until I got help. Diarrhea also. I recall laying in a fetal position in between bathroom runs. UGGHHHH

     
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