Primary adrenal insufficiency is a rare disease characterized by deficient production of glucocorticoids with or without a deficiency of mineralocorticoids and adrenal androgens.1 This disease can present as a range of symptoms provoking a visit to the emergency department (ED). In this case, we present a 40-year-old female who reported tongue and gingival discoloration, unintentional weight loss, and skin hyperpigmentation. The patient was evaluated by an endocrinologist in the ED, received a dose of steroids in the ED, and discharged home with a prescription for steroids. This case report illustrates the distinctive tongue discoloration seen in primary adrenal insufficiency, highlighting the need for early recognition in the emergency setting to enable prompt and appropriate management.
\n","language":"eng","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\n\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"endocrine"},{"word":"Addison’s disease"},{"word":"primary adrenal insufficiency"},{"word":"black tongue"},{"word":"Steroids"},{"word":"skin hyperpigmentation"}],"section":"Visual EM","is_remote":true,"remote_url":"https://escholarship.org/uc/item/2cf0w90j","frozenauthors":[{"first_name":"Kyrillos","middle_name":"","last_name":"Girgis","name_suffix":"","institution":"Loma Linda University","department":"Department of Emergency Medicine"},{"first_name":"Cory","middle_name":"","last_name":"Toomasian","name_suffix":"MD","institution":"Loma Linda University","department":"Department of Emergency Medicine"},{"first_name":"Timothy","middle_name":"","last_name":"Young","name_suffix":"MD","institution":"Loma Linda University","department":"Department of Emergency Medicine"}],"date_submitted":"2025-06-12T23:20:14Z","date_accepted":"2026-03-07T18:23:35.360732Z","date_published":"2026-04-30T12:15:00Z","render_galley":{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/uciem_jetem/article/52329/galley/49517/download/"},"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/uciem_jetem/article/52329/galley/49517/download/"}]}