Endocrine Abstracts

Addison’s disease (AD), is an autoimmune disorder. However, its association with connective tissue diseases is rare. Here, we report a case of AD associated with ankylosing spondylitis (AS).

Case: A 57-year-old male patient admitted to internal medicine polyclinic with complaints of debility and anorexia. In the physical examination, he has hyperpigmentation on his skin, gingiva and palm lines. Blood pressure was 80/50 mmHg, pulse was 64/min. The other examination data were normal. Laboratory examination revealed potassium level as 9.3 mmol/l. Within his other laboratory examination, glucose was 61 mg/dl, urea was 68.5 mg/dl, creatin was 1.6 mg/dl, sodium was 133 mmol/l. After urgent intervention for the hyperpotasemia, he transferred to Endocrinology with a diagnosis of adrenal insufficiency. His cortizol level was 2 mg/dl. Hydrocortizone was given as treatment. In few days, patient’s debility rapidly got better. His blood pressure, glucose and K levels improved. In the repeated examination, patient’s kyphosis was noticed. He described progressive kyphosis since years and morning stiffness lasts about half an hour and relieved with movement. In rheumatology examination, sacroiliac sensitivity was positive, tragus-wall distance was 25 cm, occiput-wall distance was 19 cm, chest expansion was 2 cm, Schober test was 0.8 cm, modified Schober was 1 cm, right lateral expansion was 8 cm, left lateral expansion was 6 cm and intermalleolar distance was 69 cm. Sacroiliac and vertebra X-ray revealed stage four bilateral sacroileitis with bamboo spine and syndesmophytes presence. Ophthalmology examination was normal. He was diagnosed as AS and AD.

Discussion: AD has a prevalance of 4–11/100 000. AD may develop due to a number of causes, however autoimmunity has become the main cause now. We report a case of AD associated with AS and aimed to take attention about coexistence of AD and other autoimmune disorders such as connective tissue diaseases.