Endocrine Abstracts

Case Presentation: A 69-year-old female was found unconscious on the floor at her home. She was unable to provide a reliable history due to a GCS of 8. On examination there were no Cushingoid features and normal BMI (20 kg/m²). She was previously fit and well with no significant history. Investigations revealed a hyperosmolar metabolic acidosis (pH 6.9) with a high serum sodium (174 mmol/l) and high glucose (70.5 mmol/l). Chest X-ray revealed left middle zone consolidation and imaging of the head revealed no abnormalities.

Management and Diagnosis: She received treatment for diabetic ketoacidosis (DKA) and further inquiry was conducted to investigate the cause of her DKA. Serum amylase was normal. CT of pancreas was performed to exclude pancreatic pathology as a cause but revealed a right adrenal mass and left adrenal nodule. Dexamethasone suppression tests failed to suppress cortisol with serum ACTH of less than 5 ng/l. Adrenal hormonal screen was otherwise normal. Further MRI measured the bilateral adenomas to be 46 mm and 18 mm on the right and left respectively. Patient was referred to adrenal MDT who deemed her unsuitable for surgery at this time and recommended further imaging. She was successfully managed on antihypertensives and basal insulin and metformin.

Conclusion: It is exceptionally rare for a functional adrenal adenoma to present with DKA as seen in this case. DKA is classically associated with type 1 diabetes. Yet this case highlights that, when it occurs in an older patient with no known history of diabetes, it is vital to investigate thoroughly for other causes.