A 76-year-old man with history of oesophageal carcinoma was successfully treated by surgery and radiotherapy 4 years previously. He presented with anorexia and 4 stones weight loss associated with abdominal discomfort. He was not on any medication. On examination blood pressure 100/60, no peripheral oedema, systemic examination otherwise was unremarkable. Soon after admission, he developed a generalised tonic clonic seizure requiring a Lorazepam and Phenytoin infusion to control it in critical care setting. He became hypotensive with blood pressure of 93/49. Subsequent investigations revealed significant hyponatraemia of 118 mmol/l, severe hypoglycaemia, blood glucose 1.8 mmol/l, potassium 4.4 mmol/l and serum bicarbonate 21 mmol/l. The rest of blood testes including; full blood count, liver functions, corrected calcium, urea and creatinine were all normal.
As an urgent CT head revealed no metastasis and his clinical and biochemical indices pointed towards Addisonian crisis therefore the patient was commenced on hydrocortisone, normal saline and the hypoglycaemia was treated with glucagon and dextrose. On the following day there was no further seizure activity, biochemical profile normalised and patient started mobilising independently. Short synecthen test showed a flat cortisol response consistent with adrenal failure. Furthermore, abdominal CT scan revealed bilateral adrenal enlargement with heterogeneous appearance suggestive of metastatic deposits. He was seen by the oncologist and allowed home on hydrocortisone and fludrocortisone.
We report a case of status epilepticus due to a combination of severe hyponatraemia and hypoglycaemia as a presentation of an undiagnosed Addisons disease in a patient with underlying neoplasm. Hyponatraemia and hypoglycaemia, both of which could be features of malignancy as in SIADH and hypoglycaemia with malignancy. This case highlights the importance of high index of suspicion in relevant settings to make a diagnosis of Addisons disease.