Endocrine Abstracts

A 46 year old male presented with abdominal pain, lethargy and intermittent fever. He described abdominal fullness with cramp-like pains in the left iliac fossa. He reported early satiety and flatulence, but denied weight loss. He had Addison’s disease, diagnosed 18 years earlier with similar symptoms at presentation and diagnostic short Synacthen test, treated with hydrocortisone 20 mg am and 10 mg pm with 100 mcg fludrocortisone once daily. He had however been increasing his steroids at home due to his illness, and had had two admissions within a fortnight where his symptoms were attributed to Addisonian crises. He was a non-smoker and drank minimal amounts of alcohol. A family history of coeliac disease and bowel cancer was noted. On initial admissions he was haemodynamically stable with no evidence of fever or dehydration. Plain abdominal films revealed faecal loading. His blood tests showed; Sodium 139 mmol/l, Potassium 4.4 mmol/l, Urea 6.6 mmol/l, liver function tests within normal range, elevated C-reactive protein (58.2 mg/l), with normal white cell count (6.6 10–9/l). He was re-admitted under the endocrine team for further investigation. Two days later he spiked a temperature and continued to spike every 3 days. Repeated blood and urine cultures showed no bacterial growth. CT scan of abdomen showed thickened bowel and narrowing of the proximal descending colon. All other organs appeared normal with no lymphadenopathy. Colonoscopy revealed a mass in the descending colon. Biopsies diagnosed moderately differentiated adenocarcinoma. He underwent hemicolectomy and 11 cycles of adjuvant chemotherapy. Unfortunately disease progressed and he died. This case illustrates the need to maintain clinical suspicion in patients with pre-existing diagnoses. Symptoms had previously been labelled as an Addisonian crisis with little evidence to support such a diagnosis. Admission was sought to make a definitive diagnosis with tragic consequences. Fever secondary to bowel carcinoma is well recognized in the literature.

Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.