Case presentation
A 24-year-old woman presented with hyperpigmentation at frictional sites including hands (Fig. 1A), feet, gingiva, and tongue (Fig. 1B) for two years.
Key clinical findings
The patient complained of fatigue, irritability, and poor appetite, with no abdominal pain, nausea, or vomiting. She denied a history of tuberculosis contact or autoimmune diseases. Being unmarried, she had regular menstruation. Her blood pressure was 100/70 mmHg, and she had a 2.5 kg weight loss in the past 6 months. Laboratory investigation revealed decreased morning cortisol level (1.71 μg/dL, normal from 4.20 μg/dL to 22.30 μg/dL) and increased adrenocorticotropic hormone (ACTH) (1286.7 pg/mL, normal from 5.1 to 32.0 pg/mL). T-cell enzyme-linked immunospot assay for tuberculosis (T-SPOT.TB) test showed positive results. Computed tomography (CT) scan showed adrenal calcification (Fig. 1C).
Final diagnosis
Taken together, the patient was diagnosed with Addison’s disease and adrenal tuberculosis based on clinical symptoms, adrenocortical hormone assay, T-SPOT.TB test, and adrenal CT examination.
Teaching points
Addison’s disease, also known as primary adrenal insufficiency, is a rare endocrinal disorder commonly caused by autoimmunity and tuberculosis. It is characterized by generalized hyperpigmentation (especially in overpressured areas) and symptoms of fatigue, weight loss, nausea, vomiting, etc. Some patients can develop adrenal crisis. The patient received prednisone acetate and quadruple anti-TB therapy (rifampicin, isoniazid, pyrazinamide, and ethambutol). After hospitalization, the patient’s fatigue and irritability were markedly alleviated, and her appetite improved as well. Following 6 months of treatment, pigmentation on the hands, feet, gingiva, and tongue subsided significantly. Serum cortisol and ACTH levels returned to normal limits. No adrenal crisis was observed during the entire treatment period. The patient is currently under follow-up.
Addison’s disease typically presents with hyperpigmentation on friction and pressure sites including the hands, feet, gingiva, and tongue, accompanied by fatigue, weight loss, poor appetite, irritability, etc. Adrenal crisis may occur without timely diagnosis and treatment.
The Author(s) 2026. This article is published by Higher Education Press on behalf of People’s Medical Publishing House.
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