Considering the generalized skin bronzing, diffuse mucosal pigmentation, hypotension, and salt craving together, which systemic condition is most likely?

Correct answer: B. Primary adrenal insufficiency (Addison disease)

• A. Incorrect. Cushing syndrome is cortisol excess. It produces central obesity, moon facies, a buffalo hump, striae, and hypertension — not hypotension, and not diffuse hyperpigmentation (except in the specific setting of ectopic ACTH).
• B. Correct. Destruction of the adrenal cortex removes cortisol’s negative feedback, so pituitary POMC output rises. α-MSH is cleaved from that same precursor as ACTH, and it drives melanocytes in skin and oral mucosa. The result is the classic triad seen here: generalized bronzing including non-sun-exposed skin, diffuse patchy oral pigmentation, and hypotension with salt craving from mineralocorticoid loss.
• C. Incorrect. Peutz-Jeghers produces discrete perioral and mucosal melanotic macules with intestinal hamartomatous polyps. The macules are focal and present from childhood; there is no systemic bronzing, hypotension, or salt craving.
• D. Incorrect. Graves disease causes heat intolerance, weight loss with increased appetite, tachycardia, tremor, and exophthalmos. Pretibial myxedema is localized, not a generalized bronzing, and blood pressure is typically elevated with a wide pulse pressure.

Note: Anesthetic relevance: an undiagnosed Addisonian patient is at risk of adrenal crisis under the stress of dental treatment. Defer elective care and refer for endocrine evaluation.