Which of the following describes the typical presentation and electrolyte disturbances of Addison disease?

• A. Fatigue, weakness, orthostatic hypotension, hyperpigmentation; hyponatremia, hyperkalemia, metabolic acidosis, possible hypoglycemia
• B. Weight gain with hypertension and edema
• C. Hyperglycemia with polyuria and dehydration
• D. Jaundice with pruritus and cholestasis

Answer: (A)

Addison disease is primary adrenal insufficiency, where the adrenal cortex fails to produce enough cortisol and aldosterone. This arrangement causes fatigue and weakness from low cortisol, and orthostatic hypotension from reduced vascular tone and salt/water loss due to low aldosterone. The loss of aldosterone also leads to hyponatremia and hyperkalemia, often with a metabolic acidosis from impaired hydrogen ion handling. The deficiency of cortisol stimulates increased ACTH, whose precursor also gives rise to melanocyte-stimulating hormone, producing the characteristic hyperpigmentation. Hypoglycemia can occur because cortisol helps maintain blood glucose during stress. Other options describe conditions with different pathophysiology—weight gain with hypertension and edema points to Cushing’s, hyperglycemia with polyuria to diabetes, and jaundice with pruritus to liver disease—so they don’t fit Addison’s pattern.