Abstract
Aim
Clinical symptoms of adrenal insufficiency are nonspecific and thus misdiagnosis is common. Hyperpigmentation is a specific finding for the diagnosis of primary adrenal insufficiency. This case report is presented to emphasize the importance of the presence of hyperpigmentation in the definition of primary adrenal insufficiency.
Case
A 66-year-old male with no previous history of disease presented to our emergency department with complaints of weakness, nausea, and vomiting. On his initial evaluation, blood pressure was 71/55 mmHg. Physical examination revealed darkening of skin color and increased pigmentation on hands and tongue. There were no other significant findings on physical examination. The laboratory findings of the patient were: Adrenocorticotropic hormone (ACTH)>1250 pg/mL (reference value: <46), cortisol 0.54 μg/dL (reference value: 4.82-19.5). The patient was hospitalized with the diagnosis of primary adrenal insufficiency.
Conclusion
In cases where hyperpigmentation, nausea, vomiting, and weakness accompanying unexplained hypotension, the diagnosis of primary adrenal insufficiency should be kept in mind.
References
- 1- Bornstein SR. Predisposing factors for adrenal insufficiency. N Engl J Med. 2009; 360:2328-2339.
- 2 - Marx JA, Hockberger RS, Walls RM. Rosen's Emergency Medicine. 8th Ed. Elsevier Saunders: 2014.
- 3 - Yanase T, Tajima T, Katabami T, Iwasaki Y, Tanahashi Y, Sugawara A, et al. Diagnosis and treatment of adrenal insufficiency including adrenal crisis: a Japan Endocrine Society clinical practice guideline. Endocr J. 2016;63(9):765-784.
- 4 - Nieman LK, Turner MLC. Addison’s disease. Clinics in Dermatology. 2006;24(4):276-80.
- 5 - Simpson SL. Addison’s disease. BMJ. 1950;4689:1164-6. 6 - Charmandari E, Nicolaides NC, Chrousos GP. Adrenal insufficiency. Lancet. 2014;383(9935):2152-67.
- 7 - Hahner S, Loeffler M, Bleicken B, Drechsler C, Milovanovic D, Fassnacht M, et al. Epidemiology of adrenal crisis in chronic adrenal insufficiency: the need for new prevention strategies. Eur J Endocrinol. 2010;162: 597-602.
- 8 - Adams JG, Emergency Medicine, 2nd Ed. Elsevier Saunders 2012 .
Abstract
Amaç
Adrenal yetmezliğin klinik semptomları spesifik değildir ve bu nedenle yanlış tanı yaygındır. Hiperpigmentasyon, primer adrenal yetmezlik tanısı için spesifik bir bulgudur. Bu olgu primer adrenal yetmezlik tanısında hiperpigmentasyon varlığının önemini vurgulamak amacıyla sunuldu.
Olgu
Bilinen hastalık öyküsü olmayan 66 yaşında erkek hasta acil servisimize halsizlik, bulantı ve kusma şikayetleri ile başvurdu. İlk değerlendirmesinde kan basıncı 71/55 mmHg olarak belirlendi. Fizik muayenede cilt renginde koyulaşma, el ve dilde hiperpigmentasyon görüldü. Fizik muayenede başka anlamlı bulgu saptanmadı. Hastanın laboratuvar bulgularında Adrenokortikotropik hormon (ACTH)> 1250 pg / mL (referans değeri: <46), kortizol 0.54 μg / dL (referans değeri: 4.82-19.5) olarak belirlendi. Hasta primer adrenal yetmezlik tanısı ile hastaneye yatırıldı.
Sonuç
Açıklanamayan hipotansiyona eşlik eden hiperpigmentasyon, bulantı, kusma ve halsizlik durumunda primer adrenal yetmezlik tanısı akılda tutulmalıdır.
References
- 1- Bornstein SR. Predisposing factors for adrenal insufficiency. N Engl J Med. 2009; 360:2328-2339.
- 2 - Marx JA, Hockberger RS, Walls RM. Rosen's Emergency Medicine. 8th Ed. Elsevier Saunders: 2014.
- 3 - Yanase T, Tajima T, Katabami T, Iwasaki Y, Tanahashi Y, Sugawara A, et al. Diagnosis and treatment of adrenal insufficiency including adrenal crisis: a Japan Endocrine Society clinical practice guideline. Endocr J. 2016;63(9):765-784.
- 4 - Nieman LK, Turner MLC. Addison’s disease. Clinics in Dermatology. 2006;24(4):276-80.
- 5 - Simpson SL. Addison’s disease. BMJ. 1950;4689:1164-6. 6 - Charmandari E, Nicolaides NC, Chrousos GP. Adrenal insufficiency. Lancet. 2014;383(9935):2152-67.
- 7 - Hahner S, Loeffler M, Bleicken B, Drechsler C, Milovanovic D, Fassnacht M, et al. Epidemiology of adrenal crisis in chronic adrenal insufficiency: the need for new prevention strategies. Eur J Endocrinol. 2010;162: 597-602.
- 8 - Adams JG, Emergency Medicine, 2nd Ed. Elsevier Saunders 2012 .
Details
| Primary Language | English |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Case Report |
| Authors | |
| Publication Date | March 30, 2020 |
| Published in Issue | Year 2020 Volume: 3 Issue: 1 |
