Endocrine Abstracts

Introduction: Addisson’s disease is a rare endocrine disorder; that continues to be a diagnostic challenge in the 21st century; mainly due to the slow and non specific progression of symptoms. We report the case of a 45-year-old woman who was admitted with acute adrenal insufficiency discovered in the context of a severe hyperkalemia.

Case report: A 45-year-old woman was admitted in our institution with a history of extreme weakness and vomiting. On physical examination we noticed a significant dehydration and a blood pressure of 60/40 mmHg. Initial blood tests revealed hyponatremia 124 mmol/l and severe persistant hyperkalemia higher than 10 meq/l with estimated glomerular rate 42.42 ml/min. Her ECG showed tall tented T waves in all leads besides wide QRS complexes. Furthermore, 0800 h serum cortisol was low. The patient was started on intravenous hydrocortisone and fluids according to local treatment protocol for acute adrenal insufficiency. At the same time, she underwent urgent haemofiltration along with conventional medical management of hyperkalemia resulting in subsequent improvement. Elevation of ACTH with low cortisol taken at 0800 h at discharge confirmed the diagnosis of primary adrenal insufficiency. After the resolution of the electrolyte abnormalities and the improvement of hemodynamic statement; she was discharged on oral hydrocortisone and fludrocortisone tablets.The patient was followed up in the endocrinology department of Oujda’s Mohammed VI university hospital, for further investigations and a well conducted disease’s education.

Conclusion: This report describes a non-specific presentation of Addison’s disease. Therefore, a high index of suspicion is warranted in patients with a life-threatening hyperkalemia and may requires haemofiltration in spite of a prompt management of acute adrenal insufficiency based on preliminary clinical diagnosis.