Pathology · patient case question
What is the diagnosis?
Patient case: Case: lethargy, low blood pressure and bronze skin
Scenario: A female patient is markedly lethargic. Her blood pressure is 80/60 and her skin shows a diffuse bronze pigmentation.
Show answer and explanation
Correct answer: D. Addison disease
- A. Haemochromatosis does bronze the skin through iron deposition, but it presents with diabetes and cirrhosis, not hypotension and adrenal collapse.
- B. Cushing syndrome is cortisol excess — moon face, buffalo hump, central obesity and hypertension, the opposite haemodynamic picture.
- C. Hyperthyroidism produces heat intolerance, weight loss, tremor and tachycardia, with warm moist skin rather than bronze pigmentation.
- D. Correct. Primary adrenal insufficiency lowers cortisol; the pituitary compensates with more ACTH, and the melanocyte-stimulating fragment of that molecule bronzes the skin and mucosa. Hypotension, fatigue and salt craving complete the picture.