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Medical Emergencies · single question

A lethargic female patient has a blood pressure of 80/60 mmHg and bronze skin pigmentation. What is the most likely diagnosis?

  1. Addison's disease (primary adrenal insufficiency), with hyperpigmentation from elevated ACTH/MSH and hypotension from mineralocorticoid deficiency
  2. Cushing's syndrome
  3. Graves' disease
  4. Diabetes insipidus
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Correct answer: A. Addison's disease (primary adrenal insufficiency), with hyperpigmentation from elevated ACTH/MSH and hypotension from mineralocorticoid deficiency

Addison's disease (primary adrenal insufficiency) classically presents with hypotension (from aldosterone/mineralocorticoid deficiency), fatigue/lethargy, and characteristic bronze/hyperpigmentation of the skin (from compensatory ACTH elevation, which shares a precursor with melanocyte-stimulating hormone, MSH) — essentially the clinical opposite picture from Cushing's syndrome (cortisol excess).

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