A CLINICAL CASE OF ATYPICAL PRESENTATION OF ADDISON’S DISEASE
https://doi.org/10.51922/1818-426X.2025.4.148
Abstract
Autoimmune destruction of the adrenal cortex, as the most common cause of Addison’s disease, can progress slowly, over several months and even years. The first clinical signs are often nonspecific, which is associated with delayed diagnosis and may result in the development of a life-threatening condition - adrenal crisis. The described clinical case is of interest because it presents a young patient who, despite exhibiting classical clinical manifestations of adrenal insufficiency (weakness, fatigue, dizziness, decreased blood pressure – 90/50 mm Hg, salt craving, hyperpigmentation) had hypercortisolemia with subsequent cortisol levels within the reference range. Additionally, high ACTH levels in the absence of manifestations of hypercortisolism, “borderline high” levels of serum potassium, and no abnormalities in imaging tests (MRI of the pituitary gland, CT angiography of the chest, abdominal cavity, and retroperitoneal space) increased clinical suspicion of the presence of primary adrenal insufficiency. Upon initiating glucocorticoid replacement therapy, a positive clinical response was obtained (improvement of general well-being, normalization of blood pressure and electrolyte levels).
This clinical case clearly demonstrates the difficulties and peculiarities of diagnosing primary adrenal insufficiency with an atypical presentation in modern clinical practice in the Republic of Belarus.
About the Authors
T. Mokhort
Educational Institution «Belarusian State Medical University»
Belarus
Belarus
D. Baalbaki
Educational Institution «Belarusian State Medical University»
Belarus
Belarus
A. Kuzmiankova
«Republican Center for Medical Rehabilitation and Balneotherapy»
Belarus
Belarus
References
1. Tennant, F. Addison’s Original 1855 Cases Reveal Stories of Chronic Pain // Pract Pain Manag. – 2015. – Vol. 15(10) (Available at: https://www.medcentral.com/pain/chronic/addisonoriginal-1855-cases-reveal-stories-chronic-pain).
2. Olafsson, A. S., Sigurjonsdottir H. A. Increasing Prevalence of Addison Disease: Results from A Nationwide Study // Endocrine Practice. – 2016. – Vol. 22(1). – P. 30–35. – doi: org/10.4158/EP15754.
3. Hellesen, A., Bratland E., Husebye E. S. Autoimmune Addison’s Disease – An Update on Pathogenesis // Ann Endocrinol. – 2018. – Vol. 79(3). – P. 157–163. – doi: org/10.1016/j.ando.2018.03.008.
4. Younes, N., Bourdeau I., Lacroix A. Latent Adrenal Insufficiency: From Concept to Diagnosis // Front Endocrinol (Lausanne). – 2021. – Vol.12:720769. doi: 10.3389/fendo.2021.720769.
5. Bleicken, B., Hahner S., Ventz M. et al. Delayed diagnosis of adrenal insufficiency is common: a cross-sectional study in 216 patients // Am J Med Sci. – 2010. – Vol. 339(6). – P. 525–531. – doi: 10.1097/MAJ.0b013e3181db6b7a.
6. Stefan, R., Bruno A., Wiebke A. et al. Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline // The Journal of Clinical Endocrinology & Metabolism. – 2016. – Vol. 101(2). – P. 364–389. – doi: 10.1210/jc.2015-1710.
7. Betterle, C., Scalici C., Presotto F. et al. The Natural History of Adrenal Function in Autoimmune Patients with Adrenal Autoantibodies // J Endocrinol. – 1988. – Vol. 117(3). – P. 467–475. – doi: 10.1677/joe.0.1170467
8. Hahner, S., Spinnler C., Fassnacht M. et al. High Incidence of Adrenal Crisis in Educated Patients with Chronic Adrenal Insufficiency: A Prospective Study // The Journal of Clinical Endocrinology & Metabolism – 2015. – Vol. 100(2). – P. 407–416. – doi: 10.1210/jc.2014-3191.
9. Postanovlenie MZ RB № 85 ot 21.06.2021 g. Diagnostika i lechenie pacientov s endokrinnymi zabolevaniyami gipofiza, nadpochechnikov, gonad (vzrosloe naselenie). – S. 92–95.
10. Rossijskaya Associaciya Endokrinologov. Klinicheskie rekomendacii: “Pervichnaya nadpochechnikovaya nedostatochnost’ u vzroslyh” 2025 g.
11. Wolff, A. S. B., Kucuka I., Oftedal B. E. Autoimmune primary adrenal insufficiency-current diagnostic approaches and future perspectives // Front Endocrinol (Lausanne). – 2023. – Vol. 14. – Р. 1285901. doi: 10.3389/fendo.2023.1285901.
12. Park, Y. A., Gao F., Sim I. W., Gilfillan C. Pseudo-Cushing Syndrome with an Atypically High Cortisol Burden and Clinical Improvement with Adrenal Enzyme Inhibitor // JCEM Case Rep. – 2023. – Vol. 1(4):luad075.
13. Scaroni, C., Albiger N. M., Palmieri S., Iacuaniello D., Graziadio C., Damiani L., Zilio M., Stigliano A., Colao A., Pivonello R. Altogether to Beat Cushing’s Syndrome (ABC) study group. Approach to patients with pseudo-Cushing’s states // Endocr Connect. – 2020. – Vol. 9(1). – P. 1–13. – doi: 10.1530/EC-19-0435.
14. Yunilajnen, O. A., Starostina E. G., Baranov P. A. et al. Associaciya urovnya kortizola s psihopatologicheskimi osobennostyami depressii i terapevticheskim otvetom u zhenshchin // Zhurnal nevrologii i psihiatrii im. S. S. Korsakova – 2025. – № 125(6). – S. 45–54.
Review
For citations:
Mokhort T., Baalbaki D., Kuzmiankova A. A CLINICAL CASE OF ATYPICAL PRESENTATION OF ADDISON’S DISEASE. Medical Journal. 2025;(4):148-152. (In Russ.) https://doi.org/10.51922/1818-426X.2025.4.148
Views:
59
JATS XML
Email this article 