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A 40-year-old woman presents with skin hyperpigmentation after bilateral adrenalectomy.

E The removal of the adrenal glands has removed the physiological feedback inhibition of ACTH production. Corticotrophin (which leads to the production of cortisol from the zona reticularis and zona fasciculata of the adrenal gland) and melanocyte-stimulating hormone are produced from the same progenitor hormone. Therefore, increased production of the progenitor hormone leads to greater levels of both ACTH and melanocytestimulating hormone, and subsequent excessive skin pigmentation.