(A) A 57-year-old female presented with symptoms of primary adrenal insufficiency secondary to autoimmune Addison disease. Diffuse skin hyperpigmentation had developed during the last year, as illustrated by her facial appearance.
(B) The hands demonstrate increased pigmentation of the palmar creases and wrists compared to a healthy female control (far right).
(C) With long-term glucocorticoid and mineralocorticoid therapy, her hyperpigmentation resolved, as shown by the normal palmar skin pigmentation in the patient at age 83.
Of note, she wears a medical bracelet indicating her requirement for glucocorticoids in case of severe illness.