R. Adams et al., Prompt differentiation of Addison's disease from anorexia nervosa during weight loss and vomiting, SOUTH MED J, 91(2), 1998, pp. 208-211
An 18-years-old white woman had nausea, vomiting, weight loss, and a diagno
sis of anorexia nervosa. Copper-colored skin was noted on physical examinat
ion, and serum chemistry values were normal. Subsequent fever, disorientati
on, and confusion led to the discovery of Addison's disease, which responde
d well to corticosteroid replacement therapy, Addisonian and anorexic patie
nts exhibit clinical similarities, including nausea, vomiting, weight loss,
abdominal pain, cold intolerance, hypothermia, and orthostasis, Other comm
onalities include prolongation of electrocardiographic PR and QT intervals
and generalized slowing on electroencephalogram. Important differences incl
ude a brown color to the skin in Addison's disease instead of a yellowish c
olor in anorexia. Addisonian patients also display hypocortisolism, hypogly
cemia, and hyperkalemia, in contrast to the hypercortisolism, hyperglycemia
, and hypokalemia seen in anorexia.