Salty sweat and ichthyosis in Addison's disease

Abstract

The clinical manifestations of primary chronic adrenocortical insufficiency are well known. The authors report a 54 yr old patient with Addison's disease who had 2 unusual features, namely, 'salty sweat' and ichthyosis. These features have not been reported before. Clearly the salty sweat and ichthyosis resulted from chronic adrenocortical insufficiency, as both reverted to normal after corticosteroid replacement. Changes in the electrolyte composition of sweat in adrenal disorders are familiar and have been used as an index of adrenocortical function. However, salty sweat in Addison's disease is a remarkable symptom. In this disease the excessive secretion of sodium chloride in sweat is secondary to mineralocorticoid deficiency. The acquired ichthyosis is more difficult to explain. The hydration of the skin may have been affected by the osmotically more active sweat or by the reduction of dermal blood flow due to chronic hypotension, or by a combination of both. Glucocorticoids may perhaps influence the keratinisation of the epidermis. Ichthyosis also occurs in another endocrine disorder, namely, hypothyroidism.