Dad Wu, who was nearly 60 years old, gradually developed a dark skin all over his body in July 2014. Because he was often outdoors, he initially thought it was due to the hot summer sun and did not pay attention to it. Later, he developed low fever, chest tightness, occasional chest pain, fatigue and weakness, and visited our hospital, where he was diagnosed with tuberculosis and given anti-tuberculosis treatment, and his fever and chest pain improved. In the fall and winter, Father Wu’s skin became darker and darker, and sometimes he had generalized body aches, weakness and loss of appetite. Since Father Wu has tuberculosis, is it possible that his adrenal glands are also infected with tuberculosis? Director Zhang Li gave the patient relevant tests, and the results of the adrenocortical function test showed elevated adrenocorticotropic hormone, and the magnetic resonance examination confirmed the adrenal tuberculosis. The reason for Father Wu’s darkening skin was clearly identified: it turned out that Father Wu not only had tuberculosis, but also had adrenal tuberculosis. So he was given treatment adjustments, continued anti-tuberculosis treatment, and added the hormone “hydrocortisone” replacement therapy. After the above treatment, Father Wu’s complexion gradually lightened, and his body aches and weakness improved significantly. This disease is medically known as primary hyperalgesia, also known as Addison’s disease, is a systemic disease caused by low adrenal cortical function, adrenal tuberculosis is its primary cause. The most characteristic manifestation is hyperpigmentation of the skin and mucous membranes. The pigmentation is tan, shiny and not higher than the skin surface. The distribution of the pigmentation is generalized, but is more pronounced in exposed and friction-prone areas, with white spots appearing on the skin between the pigmented areas instead. There may also be reduced blood volume, low blood pressure or upright hypotension, fasting hypoglycemia, hypogonadism, and hypothyroidism. Treatment is based on corticosteroid replacement and, in the case of tuberculosis, concurrent regular anti-tuberculosis treatment. Therefore, patients with tuberculosis who develop dark skin within a short period of time need to be alerted to adrenal tuberculosis.