Addison's disease - the difficulty of diagnosis

  • Clara Preto Department of Pediatrics, Centro Materno Infantil do Norte, Centro Hospitalar do Porto
  • Joana Correia Department of Pediatrics, Centro Materno Infantil do Norte, Centro Hospitalar do Porto
  • Marina Pinheiro Department of Pediatrics, Centro Materno Infantil do Norte, Centro Hospitalar do Porto
  • Fábio Barroso Department of Pediatrics, Centro Materno Infantil do Norte, Centro Hospitalar do Porto
  • Sara Leite Department of Pediatrics, Centro Materno Infantil do Norte, Centro Hospitalar do Porto
  • Alexandre Fernandes Department of Pediatrics, Centro Materno Infantil do Norte, Centro Hospitalar do Porto
  • Helena Cardoso Department of Pediatrics, Centro Materno Infantil do Norte, Centro Hospitalar do Porto
  • Teresa Borges Department of Pediatrics, Centro Materno Infantil do Norte, Centro Hospitalar do Porto
Keywords: Addison’s disease, adrenal insufficiency, autoimmune, gastrointestinal symptoms

Abstract

Introduction: Primary adrenal insufficiency is a rare disease, especially in pediatric age.
Case report: We report the case of a teenager with astenia with four months’ evolution, causing repeated visits to the emergency department during the previous month due gastrointestinal symptoms and a ten kilograms weight loss. In admission the patient had a reasonable general condition, hydrated and without cutaneous hyperpigmentation. Laboratory results showed hyponatremia, increased levels of corticotropin with normal cortisol levels, increased levels of renin with decreased aldosterone levels and presence of antissuprarrenal antibodies, allowing the diagnosis of autoimmune primary adrenal insufficiency. The boy started treatment with hydrocortisone and fludrocortisone with favorable response.
Discussion/conclusions: The diagnosis of Addison’s disease requires a high degree of suspicion due its unspecific symptomatology. This disease often presents gastrointestinal symptoms. Thus, towards a patient with hyponatremia accompanied by constitutional and gastrointestinal symptoms, we must always consider this diagnosis.

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Published
2018-04-13
Section
Case Reports