Derm Dx: Hyperpigmentation in a white female with fatigue, dizziness and nausea

A 40-year old white female presents to her primary care health care provider with a chief complaint of fatigue, dizziness, nausea and vomiting. She has hyperpigmented skin on her face, oral mucosa, elbow and axillae.

The patient reports a 10 lb weight loss and pubic hair alopecia during the past month. Her BP is 93/60 mm Hg lying down, and ...