A 38-year-old male presents with progressive fatigue, hyperpigmentation of palmar creases and buccal mucosa, orthostatic hypotension, and hyponatremia with hyperkalemia. What is the diagnosis?

Answer and explanation

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

  1. Step 1: Primary adrenal insufficiency (Addison disease) is characterized by autoimmune destruction of all adrenal cortical zones, causing deficiencies in cortisol, aldosterone, and adrenal androgens.
  2. Step 2: Lack of aldosterone leads to renal sodium wasting, hypovolemia, hyponatremia, and hyperkalemia.
  3. Step 3: Loss of negative feedback elevates pituitary ACTH and pro-opiomelanocortin (POMC), leading to melanocyte stimulation and mucosal hyperpigmentation.
Answer
Primary adrenal insufficiency (Addison disease).
Why not the others: 'Cushing syndrome' involves cortisol excess causing moon facies, central obesity, and hypertension; 'Secondary adrenal insufficiency' results from pituitary ACTH deficiency, sparing aldosterone and lacking hyperpigmentation; 'Conn syndrome' involves aldosterone excess leading to hypertension and hypokalemia.

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