Discoloured Tongue – Candies or Disease?

Image Source: NEJM

A middle-aged woman presented with discoloured tongue without any pain. Did she eat any coloured candies?

A 33-year-old woman presented to the dermatology clinic with a discoloured tongue for the past 3 weeks. The patient had no pain. She could not think of anything that may have triggered this discolouration. There was no history of tobacco smoking nor did she consume any bismuth compounds or coloured foods or candies.

She had no other complaints besides mild fatigue.

The patient was a known case of celiac disease. Moreover, for contraception, she had a progesterone-releasing intrauterine device placed 3 years earlier. Besides this, she was not taking any other medications.

On examination, her tongue had hyperpigmented reticular patches on the dorsal and lateral aspects of her tongue. However, buccal mucosa, palate, and gingiva were normal.

Her blood tests showed normal blood cell count, no metabolic abnormalities, no vitamin B12 deficiency, and a normal thyroid profile.

However, with further hormone testing, the patient received a diagnosis of adrenal gland insufficiency.

Adrenal glands are triangular-shaped glands seated on the top of both kidneys. This gland produces the all-time famous adrenaline. The adrenal gland’s hormones regulate blood pressure and metabolism. These also produce steroids and sex hormones too.

This patient had autoimmune adrenal insufficiency also called primary adrenal insufficiency or Addison’s disease. This, in other words, means that the gland is producing insufficient hormones.  Primary adrenal insufficiency can present with generalized skin hyperpigmentation, especially in sun-exposed areas, the palmar creases, nail beds, and mucous membranes. However, an isolated tongue discolouration, as seen in this patient, is quite less common.

The patient received oral hydrocortisone daily. Moreover, the doctors educated her regarding the red flags i.e. the symptoms of adrenal crisis including seizures, shock, and even coma. They also counselled her that she would need the medications for a lifetime.

Her tongue discolouration resolved completely within 4 to 8 weeks of treatment

Source: The New England Journal of Medicine

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Dr. Arsia Hanif has been a meritorious Healthcare professional with a proven track record throughout her academic life securing first position in her MCAT examination and then, in 2017, she successfully completed her Bachelors of Medicine and Surgery from Dow University of Health Sciences. She has had the opportunity to apply her theoretical knowledge to the real-life scenarios, as a House Officer (HO) serving at Civil Hospital. Whilst working at the Civil Hospital, she discovered that nothing satisfies her more than helping other humans in need and since then has made a commitment to implement her expertise in the field of medicine to cure the sick and regain the state of health and well-being. Being a Doctor is exactly what you’d think it’s like. She is the colleague at work that everyone wants to know but nobody wants to be. If you want to get something done, you approach her – everyone knows that! She is currently studying with Medical Council of Canada and aspires to be a leading Neurologist someday. Alongside, she has taken up medical writing to exercise her skills of delivering comprehensible version of the otherwise difficult medical literature. Her breaks comprise either of swimming, volunteering services at a Medical Camp or spending time with family.


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