Hyperpigmentation of nails in primary adrenal insufficiency

Fingers of a 28-year-old White female with Addison's disease (underneath) compared with those of a normal female (top). There is hyperpigmentation of the skin and increased pigmentation of the distal half of the nails that occurred during the period of adrenal insufficiency. The proximal half of the nails are hypopigmented, a reflection of the reduction in ACTH (corticotropin) secretion after the institution of glucocorticoid therapy.