A patient with progressive fatigue, abdominal pain, weight loss, vomiting, and hyperpigmented skin folds is most suggestive of which endocrine disorder?

A patient with progressive fatigue, abdominal pain, weight loss, vomiting, and hyperpigmented skin folds is most suggestive of which endocrine disorder?

• A. Diabetes mellitus type 1 with ketoacidosis
• B. Addison's disease
• C. Cushing syndrome
• D. Hypothyroidism

Answer: (B)

Progressive fatigue with abdominal pain, weight loss, vomiting, and especially hyperpigmented skin folds points to primary adrenal insufficiency — Addison's disease. In Addison's, the adrenal cortex fails to produce cortisol and aldosterone, causing fatigue, GI symptoms, electrolyte disturbances, and volume depletion. The lack of cortisol removes the normal negative feedback, so ACTH rises; the excess ACTH (and related POMC fragments) also stimulates melanocytes, leading to the characteristic hyperpigmentation in skin folds and other areas. This combination of low cortisol/aldosterone with high ACTH and pigmented skin is not typical of the other disorders listed: diabetic ketoacidosis presents with hyperglycemia and acidosis rather than hyperpigmentation; Cushing syndrome shows signs of excess cortisol but not generalized hyperpigmentation in folds; hypothyroidism causes fatigue and weight gain without the distinct pigmented skin finding. If Addison's is suspected, urgent evaluation of electrolytes, cortisol, and ACTH is indicated, with prompt treatment if crisis is suspected.

Progressive fatigue with abdominal pain, weight loss, vomiting, and especially hyperpigmented skin folds points to primary adrenal insufficiency — Addison's disease. In Addison's, the adrenal cortex fails to produce cortisol and aldosterone, causing fatigue, GI symptoms, electrolyte disturbances, and volume depletion. The lack of cortisol removes the normal negative feedback, so ACTH rises; the excess ACTH (and related POMC fragments) also stimulates melanocytes, leading to the characteristic hyperpigmentation in skin folds and other areas. This combination of low cortisol/aldosterone with high ACTH and pigmented skin is not typical of the other disorders listed: diabetic ketoacidosis presents with hyperglycemia and acidosis rather than hyperpigmentation; Cushing syndrome shows signs of excess cortisol but not generalized hyperpigmentation in folds; hypothyroidism causes fatigue and weight gain without the distinct pigmented skin finding. If Addison's is suspected, urgent evaluation of electrolytes, cortisol, and ACTH is indicated, with prompt treatment if crisis is suspected.