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Primary adrenal insufficiency. Skin, nail, and mucosal changes.Physical clues to AI include hyperpigmentation of the face, neck, hands, areas subject to friction such as elbows, knees, and knuckles, the buccal mucosa, areolae, scars, and moles.Other skin findings are vitiligo, secondary to autoimmune melanocyte destruction, and chronic mucocutaneous candidiasis, as part of autoimmune polyendocrinopathy type 1. In the absence of history of corticosteroid withdrawal, secondary AI is usually associated with signs of other pituitary hormone deficiencies such as growth failure, delayed puberty, secondary hypothyroidism, and diabetes insipidus.
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