Patients presenting with Addison's disease need not be pigmented

Area of Science:

• Endocrinology
• Internal Medicine

Background:

• Addison's disease, or primary adrenal insufficiency, is often characterized by hyperpigmentation.
• This physical sign is typically attributed to elevated adrenocorticotropic hormone (ACTH) levels stimulating melanocytes.

Observation:

• Three consecutive patients with Addison's disease presented without the expected increase in skin pigmentation.
• This atypical presentation posed diagnostic challenges.

Findings:

• The absence of hyperpigmentation in these cases suggests it is not a universal diagnostic criterion for Addison's disease.
• Delayed diagnosis was directly linked to the lack of this prominent physical sign.

Implications:

• Clinicians should consider Addison's disease even in the absence of hyperpigmentation.
• Early recognition and diagnosis are crucial to prevent increased morbidity associated with untreated adrenal insufficiency.