Off-season tan and blue tongue in children with ketosis

Key words: Addison’s disease, Primary adrenocortical failure, Hyperpigmentation, Hyponatraemia, Hypoglycaemia, Ketosis

Addison’s disease (primary adrenocortical failure) is a rare condition mainly of autoimmune origin. Signs and symptoms are usually mild and non-specific, as abdominal pain, failure to thrive, weight loss, anorexia, vomiting and diarrhoea associated to bronzed skin colour. The diagnosis is often delayed. The paper reports two cases of children in which the association between hyperpigmentation and dehydration with metabolic acidosis, hyponatraemia and hypoglycaemia not proportionate to concomitant vomiting led to the clinical suspect.