Addison Disease Oral Features — MFDS Part 1 MCQ

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ModerateHuman DiseaseAddison Disease Oral FeaturesMFDS Part 1

A patient is being investigated for adrenal insufficiency. Which oral finding most strongly supports primary adrenal insufficiency (Addison disease), rather than secondary adrenal insufficiency?

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Correct answer: D — Diffuse brown macular pigmentation of the buccal mucosa

Diffuse brown macular pigmentation of the buccal mucosa is characteristic of primary adrenal insufficiency and may help distinguish it from secondary adrenal insufficiency. Loss of cortisol feedback increases pituitary pro-opiomelanocortin-derived ACTH and melanocortin activity, stimulating melanin production. NICE identifies hyperpigmentation as a feature of primary adrenal insufficiency and specifically advises examination of the buccal mucosa. Gingival enlargement is more typically drug-related or associated with haematological disease. Wipeable plaques suggest oral candidosis; bilateral parotid enlargement suggests salivary, metabolic or autoimmune disease; and macroglossia is associated with conditions such as acromegaly or amyloidosis.

Reference: National Institute for Health and Care Excellence. Adrenal insufficiency: identification and management. NICE guideline NG243, recommendations 1.2.1–1.2.2. 2024. https://www.nice.org.uk/guidance/NG243/chapter/recommendations