Generalized Hyperpigmentation, in Sudanese Patient with Primary Addison's Disease as Autoimmune Manifestation of Extra Digestive Helicobacter pylori Infection

Addison's disease, or chronic adrenocortical insufficiency, is the overproduction of adrenocorticotropic hormone, ACTH, by the pituitary gland as a compensatory mechanism for decreased cortisol production by the adrenal glands. Classically, patients affected with Addison's disease develop weakness, anorexia, electrolyte imbalances: decreased sodium and chloride with increased serum potassium resulting in hypotension, and hyperpigmentation of the skin and mucous membranes. We report an undiagnosed localized hyperpigmented primary autoimmune Addison's disease as extra digestive manifestation of Helicobacter pylori infection in a 43 years old male patient, teacher, who presented with localized Palmar dark pigmentation, for 7 months duration. The case was diagnosed and confirmed by ACTH stimulating test and cortisol blood level, and is considered to be the first case (reported in Sudan) associated with H. pylori and it responded to triple therapy.