Pigmentation may occur as an isolated clinical manifestation in adults with Addison's disease. It may be present for years before the appearance of the other characteristic manifestations of adrenocortical failure. Soffer, Dorfman, and Gabrilove1 reported a patient with Addison's disease who had pigmentation as the only sign for 18 years; five others were abnormally pigmented for ten, seven, six, five, and four years, respectively, before the appearance of other evidence. The presence of pigmentation as the sole manifestation of Addison's disease in adults has been well documented by Abu Haydar et al2 and by Smith.3
Pigmentation is a frequent finding in children with Addison's disease. Of the 62 proven cases reviewed by Jaudon,4 93.3% had pigmentation. To our knowledge, no documented case of Addison's disease in a child with pigmentation as the only manifestation has been reported. Six of the cases quoted by Jaudon 4 had a
NAJJAR SS, JARRAH A. Pigmentation in Addison's DiseaseA Case in Which Pigmentation Was the Only Sign. Am J Dis Child. 1964;107(2):198–201. doi:10.1001/archpedi.1964.02080060200018
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