A 24-year-old woman presented with two years of unexplained darkening of her hands, feet, gums, and tongue. Initially dismissed as a cosmetic concern, the pigmentation was eventually identified as the first sign of a rare but serious endocrine disorder.

The patient also reported fatigue, irritability, poor appetite, and 2.5 kg of weight loss over six months. Laboratory tests revealed abnormally low cortisol levels and drastically elevated adrenocorticotropic hormone (ACTH). A positive tuberculosis test and adrenal calcification on CT scan confirmed the diagnosis of Addison’s disease caused by adrenal tuberculosis.

After treatment with prednisone and anti-tuberculosis medications, the patient’s symptoms resolved completely, and her skin pigmentation faded significantly within six months. This case underscores the vital role of dermatologists in recognizing systemic diseases through their skin manifestations. Addison’s disease can be fatal if undiagnosed, as it may progress to life-threatening adrenal crisis.

The work titled “Hyperpigmentation: Initial Sign of Addison’s Disease”, was published on Skin (published on June 4, 2026).
DOI:https://doi.org/10.2738/SKIN.2026.0021