Ans. is 'a' i.e., Pigmentation Addison's disease The predominant manifestations in Addison's disease occur due to mineralocoicoid deficiency but the symptoms are also contributed by glucocoicoid deficiency and increased ACTH FEATURES OF :- Mineralocoicoid deficiency Lack of aldosterone secretion greatly decreases renal tubular sodium reabsorption and consequently allows sodium ions, chloride ions and water to be lost into urine in great profusion. The net result is greatly decreased extracellular fluid volume. Fuhermore, hyponatremia!, hyperkalemiae and mild acidosise develop because of failure of potassium and hydrogen ions to be secreted in exchange for sodium reabsorption Adrenal insufficiency (Addison's disease) Glucocoicoid deficiency Fatigue, lack of energy o Weight loss, anorexia o Myalgia, joint pain Fever Anemia, lymphocytosis, eosinophilia Slightly increased TSH (due to loss of feedback inhibition of TSH release) Hypoglycemia (more frequent in children) Low blood pressure, postural hypotension oHyponatremia (due to loss of feedback inhibition of AVP release) Mineralocoicoid deficiency Abdominal pain, nausea, vomiting Dizziness , postural hypotension Salt craving Low blood pressure, postural hypotension Increased serum creatinine (due to volume depletion) Hyponatremiayperkalemia deficiency Lack of energy Dry and itchy skin (in women) Loss of libido (in women) o Loss of axillary and pubic hair (in women) Symptoms Hyperpigmentation (primary Al only) oAlabaster-colored pale skin (secondary Al only) (due to deficiency of POMC-derived peptides) REMEMBER The clinical features and laboratory features described above are characteristically seen only in primary addison's disease because in primary addison's disease both aldosterone and glucocoicoid are deficient, whereas In secondary addison's disease only glucocoicoid deficiency is seen. ALSO KNOW The basis for acute adrenal deficiency or addisonian crisis During conditions of physical or mental stress, large amount of glucocoicoids are secreted to cope up with the situation. But in persons with addison:s. disease, the output of glucocoicoids does not increase during stress. Thus the deficiency of glucocoicoids, when a person actually has acute need for the excessive amount of glucocoicoids produces addisonian crisis. The manifestations are produced due to extracellular fluid dehydration and low blood volume leading to circulatory shock.