Addison's disease - the difficulty of diagnosis
DOI:
https://doi.org/10.25753/BirthGrowthMJ.v27.i1.10111Keywords:
Addison’s disease, adrenal insufficiency, autoimmune, gastrointestinal symptomsAbstract
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.
Downloads
References
Auron M, Raissouni N. Adrenal Insufficiency. Pediatrics in Review 2015; 36:92-102.
Bornstein SR, Allolio B, Arlt W, Barthel A, Don-Wauchope A, Hammer GD, et al. Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2016; 101:364.
Stewart PM, Krone NP. The Adrenal Cortex. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM. Williams Textbook of Endocrinology. 12th ed. Philadelphia: Elsevier Inc; 2011. p.479-544.
Perry R, Kecha O, Paquette J, Huot C, Van Vliet G, Deal C. Primary adrenal insufficiency in children: twenty years experience at the Sainte-Justine Hospital, Montreal. J Clin Endocrinol Metab 2005; 90:3243-50.
Moser HW. Adrenoleukodystrophy: phenotype, genetics, pathogenesis and therapy. Brain 1997; 120:1485-508
Miller WL, Flück CE. Adrenal cortex and its disorders. In: Sperling MA. Pediatric Endocrinology. 4th ed. Philadelphia: Elsevier Inc; 2014. p. 471-532.
Eisenbarth GS, Gottlieb PA. Autoimmune Polyendocrine Syndromes. N Engl J Med 2004; 350:2068-2079.
Porter J, Blair J, Ross RJ. Is physiological glucocorticoid replacement important in children? Arch Dis Child 2016; 0:1-7.
Carvalho MR, Russo T, Robalo B, Pereira C, Sampaio ML. Doença de Adisson na Infância. Acta Pediatr Port 2012; 43:210-4.
Downloads
Published
How to Cite
Issue
Section
License
Copyright and Authors' Rights
All articles published in Nascer e Crescer - Birth and Growth Medical Journal are Open Access and comply with the requirements of funding agencies or academic institutions. For use by third parties, Nascer e Crescer - Birth and Growth Medical Journal adheres to the terms of the Creative Commons License "Attribution - Non-Commercial Use (CC-BY-NC)".
It is the author's responsibility to obtain permission to reproduce figures, tables, etc. from other publications.
Authors must submit a Conflict of Interest statement and an Authorship Form with the submission of the article. An e-mail will be sent to the corresponding author confirming receipt of the manuscript.
Authors are permitted to make their articles available in repositories at their home institutions, provided that they always indicate where the articles were published and adhere to the terms of the Creative Commons license.
