MOUTH PIGMENTATION

Ask the Following Questions:

1. Is there generalized pigmentation? The findings of generalized pigmentation would suggest Addison's disease, arsenic poisoning, and occasionally hemochromatosis. When there is no generalized pigmentation, one should suspect Peutz-Jeghers syndrome, chronic cachectic conditions, and acanthosis nigricans.
2. Is there hypotension or weight loss? These findings suggest Addison's disease and arsenic poisoning. If there is no hypotension or weight loss, then the mouth pigmentation and generalized pigmentation may be associated with African ancestry or Fabry's disease.

DIAGNOSTIC WORKUP

Routine laboratory workup includes a CBC, sedimentation rate, urinalysis, chemistry panel, and a VDRL test. If arsenic poisoning is suspected, hair analysis for arsenic should be done. If Addison's disease is suspected, a 24-hr urine collection for 17-hydroxysteroids and 17-ketosteroids should be done. The rapid ACTH test is a suitable alternative but usually more expensive. If Peutz-Jeghers syndrome or acanthosis nigricans is suspected, a GI series with a small bowel follow-through and a barium enema may be necessary. Endoscopy procedures may also be useful in certain cases.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.

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More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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