DAY 2 — CASE 14: A patient presents with multiple oral mucosal pigmentation, lethargy, and low blood pressure. What is the most likely diagnosis?

Correct answer: A. Addison disease (adrenal insufficiency)

• A. ADDISON DISEASE (primary adrenal insufficiency / cortisol DEFICIENCY): Classic triad = mucosal/skin pigmentation (due to elevated ACTH/MSH stimulating melanocytes) + fatigue/lethargy + HYPOTENSION (low blood pressure from aldosterone deficiency). Oral pigmentation (brown patches on buccal mucosa, gingiva, lips) is a hallmark oral finding.
• B. Hemochromatosis causes bronze skin pigmentation but is associated with diabetes, liver disease, and cardiomyopathy — not specifically low BP and mucosal oral pigmentation.
• C. Crohn disease is inflammatory bowel disease — can cause oral ulcers and cobblestone appearance but not this specific triad.
• D. Cushing syndrome (cortisol EXCESS): causes weight gain, moon face, buffalo hump, hypertension — NOT low blood pressure or mucosal pigmentation.