ENDOCRINE AND METABOLIC DISEASES, besides affecting other organs, can result in changes in cutaneous function and morphology and can lead to a complex symptomatology. Dermatologists may see some of these skin lesions first, either before the endocrinologist, or even after the internist or specialist has missed the right diagnosis. Because some skin lesions might reflect a life-threatening endocrine or metabolic disorder, identifying the underlying disorder is important, so that patients can receive corrective rather than symptomatic treatment.

In this section, we review a few endocrine and metabolic disorders in which patients may present to the dermatologist with various skin lesions and in which the diagnosis of the underlying condition must be made in a timely fashion before the patient ends up with complications that could be fatal.

HYPERPIGMENTATION AND ADDISON DISEASE

Addison disease, or primary adrenal insufficiency, can be caused by either infiltrative disorders that invade the adrenal cortex or by destructive disorders that attack the adrenal cells. In either etiology, the adrenal cortex is unable to produce and secrete adequate amounts of glucocorticoid and mineralocorticoid hormones. The most common etiology of Addison disease used to be tuberculous granulomatous disease, but with declining infection rates in the developed world, the most common cause of Addison disease today is autoimmune destruction of the adrenal glands. Other less common causes of Addison include other granulomatous fungal infections (histoplasmosis, coccidiomycosis), metastatic carcinoma infiltration of the adrenals, or bilateral adrenal hemorrhage.