Abstract Secondary adrenal insufficiency (SAI) is a rare but potentially life-threatening complication of autoimmune connective tissue disorders such as mixed connective tissue disease (MCTD). We present a case of a middle-aged woman with MCTD who developed SAI. She exhibited cutaneous hyperpigmentation, particularly over the face, palmar creases, and soles, but lacked oral mucosal pigmentation. These findings, supported by biochemical tests and imaging, were consistent with a diagnosis of SAI rather than primary adrenal insufficiency (PAI). This case emphasizes the value of cutaneous findings in early recognition and differentiation of adrenal insufficiency subtypes. Keywords Secondary adrenal insufficiency, mixed connective tissue disease, hyperpigmentation, oral mucosa, ACTH, autoimmune Introduction Adrenal insufficiency may be classified as primary (PAI), secondary (SAI), or tertiary, depending on the level of the hypothalamic-pituitary-adrenal (HPA) axis affected. SAI r...
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