Buccal hyperpigmentation due to ACTH excess

Lips and gums of a 32-year-old male demonstrating hyperpigmentation of the buccal mucosa along the line of dental occlusion (an area of repeated trauma) and of the gums (in the area of chronic inflammatory periodontal disease). The high plasma ACTH concentrations responsible for the hyperpigmentation were due, in this case, to primary adrenal insufficiency; similar changes can be seen in patients with ACTH-dependent Cushing syndrome or Nelson syndrome.