Addison's disease (primary adrenal insufficiency) presents with multiple pigmentation, lethargy, and LOW blood pressure. What is the MOST likely diagnosis and first-line treatment?

Hypothyroidism
Crohn's disease (GI condition with oral mucosal lesions, not hyperpigmentation + hypotension)
Cushing's syndrome (high cortisol — causes the opposite: hypertension, weight gain)
Addison's disease — treated with corticosteroid replacement (hydrocortisone)

Show answer and explanation

Correct answer: D. Addison's disease — treated with corticosteroid replacement (hydrocortisone)

A. Hypothyroidism causes fatigue, weight gain, cold intolerance — not hyperpigmentation or hypotension.
B. Crohn's disease causes cobblestone oral mucosa, aphthous ulcers, and GI symptoms — not the described systemic presentation.
C. Cushing's SYNDROME: excess cortisol → moon face, buffalo hump, central obesity, HYPERTENSION, and skin is thin/fragile — not hyperpigmentation + hypotension.
D. Correct. ADDISON'S DISEASE (primary adrenal insufficiency): cortisol and aldosterone are deficient. Classic presentation: bronze/tan hyperpigmentation of skin and oral mucosa (due to elevated ACTH stimulating melanocytes), fatigue, hypotension, weight loss, hyponatremia, hyperkalemia. Treatment: CORTICOSTEROID REPLACEMENT (oral hydrocortisone).

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