Metabolism Quiz
Enzyme deficiency

Addison disease

What is missing: Adrenal cortex.

Presentation
Fatigue, weight loss, low blood pressure, salt craving and darkening skin

Why the signs follow

Primary failure: cortisol and aldosterone fall while ACTH climbs, because the feedback never arrives. The pigmentation is the giveaway — ACTH is cut from POMC, the same precursor as melanocyte-stimulating hormone. A secondary (pituitary) failure has low ACTH and normal color.

Written for exam preparation, not for diagnosis.