First presentation of Addison's disease as hyperkalaemia in acute kidney injury

• Published in: BMJ case reports Vol. 2016; p. bcr2015213375
• Main Authors: Maki, Sara, Kramarz, Caroline, Maria Heister, Paula, Pasha, Kamran
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 11.05.2016; BMJ Publishing Group
• Series: Case Report
• Subjects: Acute Kidney Injury - drug therapy; Acute Kidney Injury - etiology; Addison Disease - diagnosis; Addison Disease - drug therapy; Adrenal glands; Adult; Diagnosis, Differential; Electrolytes; Family medical history; Glucose; Humans; Hydrocortisone - administration & dosage; Hydrocortisone - therapeutic use; Hyperkalemia - drug therapy; Hyperkalemia - etiology; Insulin; Kidneys; Male; Mortality; Potassium; Rare Disease; Treatment Outcome; United Kingdom; Urinalysis; Urine; White
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2015-213375

Addison's disease is a rare endocrine disorder that frequently presents with non-specific symptoms, but may deteriorate rapidly into life-threatening Addisonian crisis if left untreated. Diagnosis can be difficult in patients without a suggestive medical history. We describe a case of a 37-year-old man who was admitted with acute kidney injury and hyperkalaemia, resistant to treatment with insulin/dextrose and calcium gluconate. On clinical examination, he was found to be hyperpigmented; a subsequent random serum cortisol of 49 nmol/L affirmed the preliminary diagnosis of Addison's disease. The patient's hyperkalaemia improved on treatment with hydrocortisone, and a follow-up morning adrenocorticotropic hormone of 1051 ng/L confirmed the diagnosis.