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hello my name is dr jude oliveira im an endocrinologist from the federal university of sao paulo brazil we present a case of a 19 year old male without any medical history who presented with a four-day complaint of diffuse abdominal pain vomiting and fever on physical exam he was dehydrated tachycardic and had postural hypotension his abdominal exam called our attention to diffuse pain with equivocal rebound tenderness leading to an initial suspicion of acute appendicitis however we noticed diffuse mucocutaneous darkening mainly over the joints nail beds dorsum of the tongue and gingiva lab tests revealed profound hyponatremia and high potassium levels leading to a suspicion of addisons disease blood was drawn for cortisol nacth and he was promptly started on iv fluids and on ebola of 100 milligrams of hydrocortisone the patients symptoms rapidly improved and addisons disease was confirmed by a low cortisol and very high acth levels he tested negative for autoimmune adrenalinitis