title: Pigmentation in vitamin B12 deficiency masquerading Addison's pigmentation: A rare presentation.
abstract: A 35-year-female presented with generalized weakness, weight loss, and progressive pigmentation was worked up for suspicion of Addisons disease. On examination hyper pigmentation was noted on both palmar and dorsal aspect of hands involving knuckles, creases, feet, tongue, oral mucosa and gluteal region. There was no evidence of hypocortisolemia as initially suspected, and literature search revealed a possibility of vitamin B12 deficiency. She had megaloblastic anemia with a low serum vitamin B12, mostly due to poor dietary intake. Her hyper pigmentation resolved with vitamin B12 supplementation. Skin biopsy showed increased pigmentation at stratum spinosum and basal-layer. The mechanism of hyper pigmentation in vitamin B12 deficiency was due to an increase in melanin synthesis.
authors.affiliation: Department of Endocrinology, Sriram Chandra Bhanj Medical College and Hospital, Cuttack, Odisha, India.
authors.forename: Ritesh Kumar
authors.initials: RK
authors.lastname: Agrawala
authors.forename: Srikanta Kumar
authors.initials: SK
authors.lastname: Sahoo
authors.forename: Arun Kumar
authors.initials: AK
authors.lastname: Choudhury
authors.forename: Binoy Kumar
authors.initials: BK
authors.lastname: Mohanty
authors.forename: Anoj Kumar
authors.initials: AK
authors.lastname: Baliarsinha
keywords: Addisons disease; B12 deficiency; hyper pigmentation; vitamin B12 deficiency