Document Detail


Addison's Disease in Evolution: An Illustrative Case and Literature Review.
MedLine Citation:
PMID:  25100373     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Objectives: To present a case of symptomatic autoimmune adrenal insufficiency with initially normal serum cortisol. Also, to caution about limitations of the current diagnostic algorithm for adrenal insufficiency which does not reflect the pathophysiology of early disease.Methods: We describe the clinical presentation and relevant investigations of a patient ultimately found to have Addison's Disease, followed by a focused review of the literature.Results: A 41 year old Caucasian woman with autoimmune hypothyroidism, premature ovarian failure and microscopic colitis presented with nausea, salt craving, increased skin pigmentation and postural hypotension. Initial bloodwork revealed a normal morning cortisol of 19.2mcg/dL (n 7.2-25) but an ACTH level ten times normal 513.6pg/mL (n <52.5). Her potassium was normal but her aldosterone was 4.12ng/dL (n 12.3-62.5) and renin activity was increased (23.0 mg/dL/h, n <6.0). Six weeks after initial presentation, she was found to have anti-adrenal antibodies. It was not until ten weeks after her initial symptomatic presentation that her morning cortisol was found to be subnormal and a formal diagnosis of adrenal insufficiency was made.Conclusion: The case and literature review reveal that common diagnostic approaches will miss patients with (possibly symptomatic) early adrenal insufficiency. We suggest that serum ACTH or tests of mineralocorticoid function be included in the initial step of investigation for suspected primary adrenal insufficiency.
Authors:
Laura E Hinz; Gregory A Kline; Valerian C Dias
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-8-6
Journal Detail:
Title:  Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists     Volume:  -     ISSN:  1934-2403     ISO Abbreviation:  Endocr Pract     Publication Date:  2014 Aug 
Date Detail:
Created Date:  2014-8-7     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9607439     Medline TA:  Endocr Pract     Country:  -    
Other Details:
Languages:  ENG     Pagination:  1-14     Citation Subset:  -    
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