Adrenal Crisis Triggered by Endogenous Thyrotoxicosis: Case Series

Abstract

Objective: Describe a group of patients who presented with thyrotoxicosis and were also found to have adrenal insufficiency.Methods: Patient cases were collected over the past year at University of North Carolina at Chapel Hill. Their clinical, laboratory, exam, and imaging findings are presented along with a review of the literature.Results: Four patients presented to the emergency room with thyrotoxicosis and were diagnosed with concomitant adrenal insufficiency; three of the four were found to have adrenal crisis at presentation. Patient 1 was diagnosed with recurrent Graves thyrotoxicosis, then was subsequently diagnosed with secondary adrenal insufficiency due to lymphocytic hypophysitis. Patients 2 through 4 were given a new diagnosis of Graves thyrotoxicosis, then were subsequently found to also have primary adrenal insufficiency. Conclusion:It is important to recognize the possibility of adrenal insufficiency in patients with autoimmune hyperthyroidism who have an atypical presentation. Thyrotoxicosis can trigger adrenal crisis in patients with concomitant adrenal insufficiency; thus, any delay in diagnosis is potentially life threatening. (AACE Clinical Case Rep. 2018;4:e346-e349) Abbreviations: ACTH = adrenocorticotropic hormone; T3 = triiodothyronine; T4 = thyroxine; TSH = thyroid-stimulating hormone