Final answer:
Congenital adrenal hyperplasia (CAH) manifests as hyperpigmentation and virilization, due to enzyme deficiencies leading to hormone imbalances.
Step-by-step explanation:
The manifestations of congenital adrenal hyperplasia (CAH) most closely relate to option D: Hyperpigmentation and virilization. CAH is caused by an enzyme deficiency that leads to the excess production of androgens by the adrenal glands, resulting in the development of male secondary sexual characteristics (virilization) in females and premature sexual development in males. Additionally, due to the overproduction of another class of hormones, people with CAH may experience hyperpigmentation due to an increase in melanocyte-stimulating hormones.