Endocrinology Cushing Adrenal

Hyperpigmentation

Hyperpigmentation can be a sign of ACTH-independent (primary) adrenal insufficiency. High levels of ACTH found in these patients stimulate the melanocortin-1 receptor in the skin, resulting in hyperpigmentation. It tends to first occur in areas of the skin under pressure, including elbows, knuckles, palmar creases, lips, and buccal mucosa.
Endocrinology

Patient 1

This is a previously healthy middle-aged man who presented with severe abdominal pain, hypotension, and colitis on cross-sectional imaging. He described many years of skin darkening, fatigue, and abdominal pain. After the history and examination, the patient was suspected to have adrenal crisis, which was confirmed with biochemical testing. Prior to this presentation, the patient had seen several doctors over the years, including a dermatologist, but he remained undiagnosed.