Patient Case: Generalized Hyperpigmentation
A 48-year-old man presents to a dermatology clinic with gradual darkening of his skin over the past eight months. He reports that his skin has become darker overall, especially in sun-exposed areas, but also on his palms, soles, and inside his mouth. He has been experiencing fatigue, unintentional weight loss, and occasional dizziness.
His medical history includes chronic fatigue and salt cravings, but no known allergies or previous dermatological conditions. He is not on any medications and denies excessive sun exposure or the use of skin-lightening products.
On examination, he has diffuse, bronze-like hyperpigmentation, particularly on the knuckles, elbows, and gingival mucosa. His blood pressure is low at 90/60 mmHg, and he appears somewhat dehydrated.
Given the clinical findings, laboratory tests are ordered, revealing low cortisol levels and elevated ACTH, confirming a diagnosis of Addison’s disease (primary adrenal insufficiency). He is started on glucocorticoid and mineralocorticoid replacement therapy, and his hyperpigmentation is expected to gradually improve with treatment.
- What is the most likely cause of this patient’s generalized hyperpigmentation?
a) Addison’s disease
b) Hemochromatosis
c) Melasma
d) Acanthosis nigricans - Which additional symptom is most suggestive of Addison’s disease in this patient?
a) Hypertension
b) Salt cravings and fatigue
c) Rapid weight gain
d) Excessive sweating - Which laboratory finding would confirm the diagnosis of Addison’s disease?
a) High cortisol and low ACTH
b) Low cortisol and high ACTH
c) Normal cortisol and ACTH levels
d) Elevated blood glucose - What is the primary treatment for Addison’s disease?
a) Topical steroids
b) Glucocorticoid and mineralocorticoid replacement
c) Phototherapy
d) Iron chelation therapy
