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CPE-008 · Screening
AI-02: Hyperpigmentation
Hyperpigmentation. Evaluates skin, scar, gum or palmar-crease hyperpigmentation documented.
Condition
- skin, scar, gum or palmar-crease hyperpigmentation documented
What it reports
- A strong clue to primary adrenal insufficiency (ACTH excess): testing is warranted
Diagnostic boundary
- Not diagnostic; sun exposure and other causes are common.
Evidence
- EV-ES-PAI-2016Bornstein SR, Allolio B, Arlt W, et al. Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016;101(2):364-389.Supports: Morning cortisol and ACTH as first tests; ACTH stimulation with 250 µg cosyntropin; peak cortisol below 18 µg/dL as insufficient Suspected adrenal crisis must be treated without waiting for tests
Cases where this rule fires
Open a case to see this rule fire with real inputs, then change the values until it stops.
ADR-FX-01
Low sodium, high potassium, weight loss and nausea
A 44-year-old with hyperpigmented scars.
ADR-FX-02
Hyperpigmentation and fatigue
No labs yet.
ADR-FX-17
Cortisol 14 on an oral contraceptive
Binding globulin raises total cortisol.
ADR-FX-19
Potassium 6.4, sodium 126 and hyperpigmentation
Severe metabolic derangement.
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