An Unusual Presentation of Addison's Disease-A Case Report

Abstract

Addison’s disease is most commonly due to autoimmune adrenalitis and tuberculosis and refers to primary hypoadrenalism caused by a total or near total destruction or dysfunction of both adrenal cortices. Usual manifestations involve chronic fatigue, muscle weakness, loss of appetite, nausea, vomiting, diarrhea, hypotension and hyperpigmentation of skin. We herein report a case of primary adrenal insufficiency presenting with fever and seizures in an 11-yr-old boy. His symptoms resolved after starting specific therapy. This kind of presentation of Addison’s disease is rather unusual.

Neuropsychiatric Manifestation of Addison's Disease: A Rare Case Report

“…Neuropsychiatric symptoms include psychosis, mood disturbances. Motivation and behavior during the crisis are two of the unusual presentations of AD, hence making the diagnosis more challenging [4-6]. In this case report we present a case of AD with neuropsychiatric manifestations and Addisonian crises.…”

A Case of Primary and Secondary Adrenal Insufficiency in Children

“…In the next few days, she developed hyperkalemia and her potassium was raised to 7 mmol/L. Choudhary et al 6 also presented a case of adrenal insufficiency in which a boy presented with generalized tonic-clonic seizures and hyperpigmentation. Uncommon and atypical presentations like those of primary adrenal insufficiency such as Addison’s disease manifesting as pseudotumor cerebri, 7 adrenal crisis associated with sciatica-like pain, 8 and Addison’s disease mimicking as anorexia nervosa 9 makes adrenal insufficiency really hard to diagnose.…”

Endocrine disorders and the neurologic manifestations

“…Primary adrenal insufficiency includes CAH, APS, ACTH resistance, adrenoleukodystrophy, adrenal hypoplasia congenita, adrenal hemorrhage, and IMAGe (intrauterine growth restriction, metaphyseal dysplasia, adrenal hypoplasia congenita, and genital anomalies) syndrome 42 , 43) . Hypotension, hyperpigmentation, hyponatremia, hyperkalemia, and hypoglycemia are presenting signs.…”

“…Hyperkalemia may not be found in primary adrenal insufficiency in childhood, thus the absence of hyperkalemia cannot rule out this condition 42) . Adrenal insufficiency should be suspected in the presence of a combination of chronic or subacute clinical symptoms including chronic fatigue, muscle weakness, anorexia, nausea, vomiting, diarrhea, hypotension, weight loss, headache and skin hyperpigmentation 42 , 43 , 44) . Serum ACTH, aldosterone or plasma renin activity can be included in the initial step evaluating suspected primary adrenal insufficiency.…”