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What causes hyperpigmentation and hyperkalemia?

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Practicing since : 2001
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what would cause hyperkalemia, overall golden brown skin darkening (no yellow whites of eyes), and hives all over? patient is type ii diabetic.
Sat, 9 Jun 2018 in Medicines and Side Effects
Answered by Dr. Shehzad Topiwala 25 hours later
Brief Answer:
Adrenal or Iron related possibility

Detailed Answer:
Sorry to learn about the patient's bothersome symptoms.

One condition that causes hyperkalemia and skin hyperpigmentation is primary adrenal insufficiency in which the adrenal glands start failing and make inadequate amounts of cortisol.

Otherwise, they can occur independently as two separate disorders.

Hyperkalemia has multiple causes such as certain medications and kidney disease.

Golden brown pigmentation is unusual and jaundice needs to be considered as you have also mentioned. Yellowing of the skin and eye sclerae is not 100% reliable and so a blood test to confirm this will be necessary.

There is another condition called Hemochromatosis which leads to accumulation of excess iron in the body. This can cause both skin pigmentation and diabetes.

When I see someone like him in my practice, I typically order the following blood tests in addition to a detailed physical examination:

CBC (Complete Blood Count, also known as Hemogram; includes Hemoglobin, WBC and Platelet counts)
Electrolytes (Sodium and Potassium in particular)
HbA1c (Glycosylated Hemoglobin = your last 3 months' glucose average). Also known by other names such as GlycoHemoglobin or Glycated Hemoglobin or A1c
Liver function tests (SGOT , SGPT, Albumin, Bilirubin, Alkaline Phosphatase)
Kidney function tests (BUN, Creatinine)
TSH (checks your thyroid)
8 am cortisol
Serum Ferritin 12 hour Fasting Lipid profile
Urine albumin to Creatinine Ratio (early sign of diabetes affecting the kidney)
25 hydroxy Vitamin D levels (ideal range 40 to 60 ng/ml = 100 to 150 nmol/liter)

Correct diagnosis and treatment requires the opportunity to examine the patient so you must see an endocrinologist in-person.
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