Primary adrenal insufficiency is termed Addison disease when an autoimmune process causes the condition and is a rare but potentially life-threatening emergency condition. Causes: results from the destruction of the bilateral adrenal cortex, leading to decreased adrenal hormones, including cortisol, aldosterone, and androgens. Addison disease's insidious course of action usually presents with glucocorticoid deficiency followed by mineralocorticoid. However, the condition can also present acutely, often triggered by an intercurrent illness. The presentation of adrenal insufficiency depends on the rate and extent of adrenal function involvement. The most common cause of primary adrenal insufficiency is Addison disease, associated with increased levels of 21-hydroxylase antibodies. 7. Clinical pictures: Multiple skin pigmentation. A: Hyperpigmentation on the skin of the face, mouth, tongue and mucous membranes of the lips; B-D: Hyperpigmentation on nails, hands and feet. Diagnostic tests: Complications: Several complications can occur due to Addison disease or secondary to inappropriate