Medical Emergencies · single question
A patient presents with hyperpigmentation, extreme lethargy, and LOW blood pressure. Which condition may be present?
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Correct answer: A. Addison's Disease
Addison's Disease (A) — primary adrenal insufficiency. The triad: hyperpigmentation + hypotension + lethargy is classic Addison's. Due to low cortisol and aldosterone from adrenal cortex destruction (autoimmune most common).
• Hyperpigmentation: caused by elevated ACTH/MSH (pituitary tries to stimulate the failing adrenal gland) — affects buccal mucosa, gingiva, and skin (classic oral sign!).
• Hypotension: from aldosterone deficiency → sodium loss → reduced blood volume.
• Cushing's Syndrome (B): EXCESS cortisol → hypertension, moon face, buffalo hump, central obesity — OPPOSITE presentation.
• Critical dental relevance: patients on long-term steroids (for Addison's) may need steroid supplementation (stress dosing) before major dental procedures.
• Hyperpigmentation: caused by elevated ACTH/MSH (pituitary tries to stimulate the failing adrenal gland) — affects buccal mucosa, gingiva, and skin (classic oral sign!).
• Hypotension: from aldosterone deficiency → sodium loss → reduced blood volume.
• Cushing's Syndrome (B): EXCESS cortisol → hypertension, moon face, buffalo hump, central obesity — OPPOSITE presentation.
• Critical dental relevance: patients on long-term steroids (for Addison's) may need steroid supplementation (stress dosing) before major dental procedures.
- A. Hypoparathyroidism causes hypocalcemia (muscle cramps, tetany) — not hyperpigmentation and hypotension.
- B. Hypothyroidism causes fatigue plus weight gain, dry skin, cold intolerance — not the classic hyperpigmentation or severe hypotension of Addison's.
- C. Addison's disease (primary adrenal insufficiency) classically presents with: (1) hyperpigmentation of skin/mucosa (elevated ACTH stimulates melanocytes), (2) severe fatigue/lethargy, and (3) hypotension (aldosterone deficiency causes sodium loss). The triad of hyperpigmentation + lethargy + low BP is pathognomonic.
- D. Cushing's syndrome (excess cortisol) causes the OPPOSITE: hypertension (not hypotension), central obesity, moon face — and does NOT cause hyperpigmentation.
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