Case: lethargy, low blood pressure and bronze skin

Correct answer: D. Addison disease

• A. Haemochromatosis does bronze the skin through iron deposition, but it presents with diabetes and cirrhosis, not hypotension and adrenal collapse.
• B. Cushing syndrome is cortisol excess — moon face, buffalo hump, central obesity and hypertension, the opposite haemodynamic picture.
• C. Hyperthyroidism produces heat intolerance, weight loss, tremor and tachycardia, with warm moist skin rather than bronze pigmentation.
• D. Correct. Primary adrenal insufficiency lowers cortisol; the pituitary compensates with more ACTH, and the melanocyte-stimulating fragment of that molecule bronzes the skin and mucosa. Hypotension, fatigue and salt craving complete the picture.

Correct answer: D. Refer to a physician for diagnosis and medical management

• A. Fludrocortisone is a mineralocorticoid used in confirmed adrenal insufficiency, again a physician's prescription after diagnosis.
• B. Steroid replacement is a physician's decision requiring biochemical confirmation and titration. Starting steroids blindly can mask the diagnosis and cause harm.
• C. Proceeding with elective treatment in an unstabilised patient risks precipitating an adrenal crisis — hypotension, collapse and shock.
• D. Correct. This is an undiagnosed systemic endocrine disorder. It needs medical workup and stabilisation before any elective dental care; the dentist's role is timely referral.

Note: Once diagnosed and stabilised, the concern shifts to adrenal crisis under stress. Discuss any need for supplemental steroid cover with the physician rather than assuming it.