A 43-year-old woman with a 1-year history of 6-kg weight loss and weakness was diagnosed with primary hypothyroidism and started levothyroxine one week before. She presented to the emergency department with a 4-day history of abdominal pain and vomiting. Physical examination revealed BP 80/35mmHg, HR 110bpm, afebrile, slim build and generalized cutaneous hyperpigmentation, especially in the knuckles, the palmar and plantar creases (Fig. 1) and involving gingival mucosa and mucosal surface of lower lip (Fig.
