Clinical manifestations of adrenocoical insufficiency include hyperkalemia, hyponatremia, hypoglycemia, fever, weight loss, and dehydration. There is excessive sodium loss in the urine, contraction of the plasma volume, and perhaps hypotension or shock. Classic hyperpigmentation is present in chronic Addison disease only. Addison disease may present in newborns as a congenital atrophy, as an insidious chronic state often caused by tuberculosis, as an acute dysfunction secondary to trauma or adrenal hemorrhage, or as a semiacute adrenal insufficiency seen during stress or surgery. In this last instance, signs and symptoms include nausea, lassitude, vomiting, fever, progressive salt wasting, hyperkalemia, and hypoglycemia. It may be confirmed by measurements of urinary Na + loss and absence of response to adrenocoicotropic hormone (ACTH).