Endocrine Abstracts

Addison’s disease (AD), also known as primary adrenal insufficiency, is caused by destruction or dysfunction of the adrenal cortex, resulting in hypocortisolism. The usual clinical features of chronic AD are non-specific and include fatigue, nausea, vomiting and hyperpigmentation. We describe the case of a 58-year-old African black male with AD presenting with recurring severe hypoglycaemia. The patient was admitted several times to the emergency department with hypoglycaemia (blood glucose between 26 and 50 mg/dl) and loss of consciousness, managed with intravenous dextrose. These episodes were associated with anorexia, dizziness, fatigue and progressive weight loss over two years prior to presentation. His past history was significant for pulmonary tuberculosis, and there was no family history of note. Physical examination revealed a cachectic habitus, depressed mood and hyperpigmentation of palmar creases and oral mucosa. He had a body mass index of 14.9, blood pressure 98/57 mmHg and regular pulse of 64 bpm, with no other remarks on systemic examination. Biochemical analysis revealed Hb 11 g/dl, mild hyponatremia (134 meq/l), normokalemia (4.1 meq/l), hypoalbuminemia (32.4 g/l), and normal renal and hepatic function tests. Morning serum cortisol level was 2.3 μg/dl and ACTH 52.2 pg/ml, with normal levels of other pituitary hormones. ACTH stimulation test was performed and confirmed adrenal insufficiency. Computerised tomography scan of the abdomen showed normal shaped and sized adrenal glands. HIV screening was negative and there were no clinical or radiological signs of active tuberculosis. He started treatment with hydrocortisone and fludrocortisone, and his symptoms readily improved. This case illustrates an unusual presentation of Addison’s disease and points out the need for a high index of suspicion so that morbidity and mortality can be decreased by a prompt diagnosis.