Hyponatremia is a common cause of hospitalization in older adults. Addison's disease (AD), an uncommon cause of hyponatremia, is primary adrenal insufficiency (AI) caused by autoimmune adrenalitis, infections, adrenal hemorrhage, or infiltration. Autoimmune adrenalitis is an uncommon cause of AD after age 60 years. We report the case of an 80-year-old female with steroid-controlled asthma, who was diagnosed with primary AI after presenting with weakness, nausea, vomiting, and hyponatremia two weeks after a urinary tract infection (UTI). Further testing revealed a positive 21 hydroxylase antibody confirming autoimmune AD. The patient has done well on hydrocortisone and fludrocortisone daily with occasional need for stress dosing during infections. AD should be considered as a cause of hyponatremia in hospitalized elderly patients. Non-specificity of symptoms of AD makes the diagnosis difficult in this age group, often causing delays in the appropriate management. Our patient's autoimmune AD was masked by intermittent steroid use over the years. During the COVID-19 pandemic, masking and social distancing decreased her steroid needs and unmasked AD after the UTI. We highlight the importance of considering AD as a cause of hyponatremia and autoimmune AD as a cause of AI even in the elderly.
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http://dx.doi.org/10.7759/cureus.42201 | DOI Listing |
Mol Genet Genomic Med
January 2025
College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
Background: The use of exome sequencing (ES) has helped in detecting many variants and genes that cause primary adrenal insufficiency (PAI). The diagnosis of PAI is difficult and can be life-threatening if not treated urgently. Consanguinity can impact the detection of recessively inherited genes.
View Article and Find Full Text PDFVet Sci
January 2025
Department of Clinics, Faculty of Veterinary Medicine, "Ion Ionescu de la Brad" Iasi University of Life Sciences, 700490 Iasi, Romania.
A 3-year-old spayed male mixed-breed Labrador presented to the Emergency and Critical Care Unit with lethargy, loss of appetite, vomiting, a recent history of presyncopal episodes, and severe exercise intolerance. On admission, the patient had bradycardia, low blood pressure, and mild abdominal pain. Serum biochemistry information revealed severe hyperkalemia, hyponatremia, hypoglycemia, and mildly increased liver and kidney parameters.
View Article and Find Full Text PDFCureus
December 2024
Division of Internal Medicine, Unidade Local de Saúde de Braga, Braga, PRT.
Autoimmune polyglandular syndrome type 3 (APS-3) is an uncommon condition marked by autoimmune thyroid disease (ATD) linked with other autoimmune issues, excluding Addison's disease. We report a case of a 41-year-old man who was hospitalized due to exhaustion and macrocytic anemia, later diagnosed with APS-3, which included Hashimoto's thyroiditis, pernicious anemia resulting from autoimmune gastritis, and pre-existing vitiligo. Diagnostic results indicated positive intrinsic factor antibodies, a gastric biopsy compatible with gastritis, elevated thyroid peroxidase antibodies, and significant findings from a thyroid ultrasound.
View Article and Find Full Text PDFRev Med Liege
January 2025
Service d'Endocrinologie, CHU Liège, Belgique.
In 1849, Thomas Addison discovered alterations in the adrenal glands at autopsy of three patients who had died with idiopathic anemia. Struck by Addison's work, Charles-Edouard Brown-Séquard demonstrated in 1851 that bilateral adrenalectomy in dogs was fatal. It was not until 1950 that the discovery of the hormones of the adrenal cortex, their structure and their biological effects allowed Kendall, Reichstein and Hench to win the Nobel Prize in Physiology or Medicine.
View Article and Find Full Text PDFFront Vet Sci
December 2024
Faculty of Veterinary Medicine, Veterinary Teaching Hospital, University of Lisbon, Lisbon, Portugal.
Background: A resting cortisol concentration (RC) higher than 2.0 μg/dL (55 nmol/L) is commonly used to rule out hypoadrenocorticism (HA). However, there is a significant overlap of RC between dogs with HA and those with other diseases.
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