The clinical features of chronic primary adrenal insufficiency are nonspecific, with most patients complaining of generalized weakness, fatigue, anorexia, and weight loss. GI symptoms are common, especially nausea, vomiting, and abdominal pain. The patient may present with dizziness secondary to postural hypotension and, uncommonly, with salt craving. Electrolytes abnormalities are frequently seen, and include hyponatremia, hyperkalemia and, on occasion, hypercalcemia. Our patient’s hypokalemia was likely secondary to vomiting. Hyperpigmentation is one of the characteristic physical findings in primary adrenal insufficiency, although it is absent in secondary and tertiary adrenal insufficiency. The hyperpigmentation is usually generalized and most pronounced in the palmer creases, areola, and areas exposed to long-term friction or light, as demonstrated in our patient. Patchy mucosal pigmentation may also occur on the inner surface of the lips and on the buccal mucosa.