A 45-year-old man presents with fatigue, weight loss, hyperpigmentation of skin creases and buccal mucosa, hypotension, hyponatremia, and hyperkalemia. In the Indian subcontinent, the most common cause of primary adrenal insufficiency (Addison disease) is:

• A Autoimmune adrenalitis
• B Tuberculosis of the adrenal glands ✓
• C HIV adrenalitis due to CMV
• D Bilateral adrenal hemorrhage (Waterhouse-Friderichsen syndrome)

Explanation

In India and developing nations, tuberculous adrenalitis remains the most common cause of Addison disease, typically causing calcified, enlarged adrenals. Autoimmune adrenalitis is the most common cause in Western countries. Waterhouse-Friderichsen is acute and presents with DCM and shock. CMV adrenalitis occurs in advanced HIV.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.