A nurse is assessing a client who has adrenal insufficiency. Which of the following findings should the nurse expect?

Adrenal insufficiency occurs when the adrenal cortex does not produce adequate amounts of cortisol and, in some cases, aldosterone. This condition affects metabolism, fluid and electrolyte balance, and the body’s response to stress. In primary adrenal insufficiency (Addison’s disease), decreased cortisol leads to increased production of adrenocorticotropic hormone (ACTH), which can stimulate melanocytes and cause characteristic skin changes. Recognizing these clinical features is essential for early diagnosis and management. A. Increased body hair is not a typical finding in adrenal insufficiency; it is more commonly associated with excess androgen or cortisol states such as Cushing’s syndrome. In adrenal insufficiency, hormone production is decreased rather than increased, so hirsutism is not expected. B. Hypocalcemia is not a defining feature of adrenal insufficiency. Electrolyte imbalances more commonly include hyponatremia and hyperkalemia due to aldosterone deficiency. Calcium levels are usually not significantly affected in this condition. C. Decreased blood urea nitrogen (BUN) level is not associated with adrenal insufficiency. In fact, dehydration from fluid loss may lead to an increased BUN. Therefore, a low BUN is not an expected finding in this disorder. D. Hyperpigmentation of the skin is a classic finding in primary adrenal insufficiency due to elevated ACTH levels. ACTH has a melanocyte-stimulating effect, leading to increased melanin production and darkening of the skin, especially in sun-exposed areas, pressure points, and mucous membranes. This is a hallmark sign that helps differentiate primary from secondary adrenal insufficiency.