Chronic Primary Adrenal Insufficiency without Hyperpigmentation

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Abstract
SINCE chronic primary adrenal insufficiency was first described by Addison1 in 1855 hyperpigmentation of mucous membranes and skin, particularly of pressure points, areolas, genitalia and scars, has been considered a cardinal manifestation of the disease.2 3 4 For this reason physicians are wary of diagnosing primary adrenal insufficiency in the absence of hyperpigmentation. In the cases in which adrenal insufficiency has been established in the absence of hyperpigmentation it has been considered an acute event or secondary to insufficiency of one or more pituitary trophic hormones. Chronic adrenal insufficiency without hyperpigmentation has rarely been confirmed by appropriate determinations of adrenal steroids.5 , 6 With . . .