The Importance of Early Recognition and Prompt Treatment of Adrenal Crisis and Addison's Disease

Objective − The aim of the paper was to emphasize the importance of early recognition and urgent treatment of adrenal crisis due to Addison’s disease in order to prevent potential lethal outcome. Case Report − A 13-year-old boy was presented to the emergency room with 2-days of vomiting, fatigue, and weakness, without diarrhea or fever. On admission he was in hypovolemic shock, febrile and hypoglycemic. The initial diagnosis was septic shock and the patient was treated with intravenous boluses, dobutamine and antibiotics. Blood pressure was consistently low despite adequate dose of dobutamine and intravenous hydration and the patient had hypoglycemia on two occasions. Subsequently, Addison’s disease was diagnosed on the basis of hyperpigmentation of the skin, low basal cortisol and high ACTH. He rapidly responded to intravenous stress doses of hydrocortisone, followed by hydrocortisone and fludrocortisone oral replacement therapy. Conclusion − Addison’s disease can be easily missed due to nonspecific symptoms and presentations, rarity of the condition, and low index of suspicion. In every patient with hyperpigmentation, hyponatremia, hyperkalemia, acidosis, and hypoglycemia, the diagnosis of Addison’s disease should be strongly suspected.