A client with Addison's disease commonly presents with which classic sign?

• A. Ecchymosis
• B. Hyperreflexia
• C. Exophthalmos
• D. Hyperpigmentation

Answer: (D)

Hyperpigmentation is the classic sign because primary adrenal insufficiency (Addison’s disease) leads to a lack of cortisol with a compensatory rise in ACTH. ACTH comes from the same precursor as melanocyte-stimulating hormone, so higher ACTH levels stimulate melanocytes and cause increased melanin production. This results in darkened skin in sun-exposed areas, folds, scars, and mucous membranes, and it can be seen even in areas that aren’t normally exposed to sunlight.

Other features aren’t as characteristic. Ecchymosis isn’t specific to Addison’s and points more toward bleeding or coagulation issues. Hyperreflexia is associated with overactivity of the nervous system, such as in hyperthyroidism or CNS conditions. Exophthalmos is a hallmark of Graves disease. So the presence of hyperpigmentation helps distinguish Addison’s from these other conditions.