**Question:** Cushing's disease presents with-

A. easy bruising
B. weight loss
C. hypertension
D. hyperpigmentation

**Core Concept:** Cushing's disease is a rare cause of hypercortisolism, characterized by elevated cortisol levels due to excessive ACTH production from a pituitary tumor (adenoma).

**Why the Correct Answer is Right:** The correct answer is D. hyperpigmentation, as it is a characteristic skin sign of Cushing's disease. Elevated cortisol levels lead to increased mineralocorticoid activity, causing skin to become thick and darker due to increased melanin production.

**Why Each Wrong Option is Incorrect:**

A. Easy bruising (hematomas) is not a typical presentation of Cushing's disease. It is more commonly associated with hypocortisolism, such as in adrenal insufficiency.

B. Weight loss is a more common presentation of hypercortisolism, while weight gain is seen in hypocortisolism, such as in Addison's disease.

C. Hypertension is more often seen in hypocortisolism, particularly in Addison's disease, rather than hypercortisolism like in Cushing's disease.

**Clinical Pearl:** Cushing's disease can be differentiated from other causes of hypercortisolism (e.g., ACTH-independent adrenal tumors) through a thorough clinical examination and appropriate investigations.

**Correct Answer:** D. hyperpigmentation