Photoclinic

A 37-year-old woman was referred to the emergency department of Hospital Universitario Central de Asturias, Oviedo, Asturias, with low blood pressure and intense asthenia. She also complained of hyporexia and progressive tanning without having been sunbathing. She had a history of abdominal pain and drowsiness that began 3 months ago, but no vomiting was associated. Vital signs were: blood pressure: 85/43 mm Hg, pulse rate: 97/min, respiratory rate: 18/min, axillary temperature: 36.5°C. On physical examination, remarkable hyperpigmentation was observed in gums, perilabial skin, knuckles and nipples. Laboratory test results: WBC: 10300/mm3, Hb: 10.5 g/dL, HCT: 32.9, MCV: 75.8, PLT: 27000/mm3, total serum protein: 5.6 g/dL, serum album: 4.1 g/dL, total bilirubin: 0.7 sodium 123 mEq/L, potassium 5.6 mEq/L.