ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2019) 63 EP9 | DOI: 10.1530/endoabs.63.EP9

Singultus persistens as a presentation of addisonian crisis

Srdjan Pandurevic1, Ljiljana Marina1,2, Miomira Ivovic1,2, Milina Tancic-Gajic1,2, Zorana Arizanovic1, Antoan Stefan Sojat1, Aleksandra Kendereski1,2 & Svetlana Vujovic1,2


1Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Belgrade, Serbia; 2Faculty of Medicine, University of Belgrade, Belgrade, Serbia.


Introduction: It is presumed that hiccups are a vestigial reflex in mammals. They are rather common in healthy subjects. Persistent hiccups (lasting >48 h) are a serious clinical sign, and documented in a number of debilitating conditions. According to the available literature persistent hiccups in Addisonian crisis have been previously documented in only two patients.

Case report: In July 2018, a 39 year old man checked into the ER complaining of nausea, vomiting, severe fatigue and persistent hiccups that started 3 days before. Detailed history revealed that the tanning of his skin started two years ago. Fatigue started a year ago, and was worsening since – for the last 3 weeks he struggled to get out of his bed and walk. Other than a penicillin allergy, he denied any other health issues. Basic metabolic panel showed severe hyponatriemia (115 mmol/l) and hyperkaliemia (5.9 mmol/l). Head CT was nominal. He was admitted to our Clinic with a diagnosis of Addisonian crisis and given hydrocortisone intravenously. Six hours after the first dose, nausea and hiccups resolved. Upon admission, serum cortisol was 54 nmol/l and ACTH >440.4 pmol/l. Thorough analysis did not reveal any other endocrinopathies. As he was getting better he was gradually transitioned from IV to oral hydrocortisone and fludrocortisone therapy. His electrolyte levels normalised and fatigue waned. He was released on hydrocortisone and fludrocortisone therapy and was educated on proper therapy modifications in acute stress situations. After 6 months he was complaint-free with quality of life approaching the one before first symptoms.

Conclusion: The rare underlying condition behind persistent hiccups was Addison’s disease with, for now, a poorly understood cause-effect relationship.

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