Posters

Discipline Track

Patient Care

Abstract

Background: Addison’s Disease, also known as primary adrenal insufficiency, is a rare disorder of the adrenal gland typically characterized by the combination of cortisol and mineralocorticoid deficiencies in addition to electrolyte abnormalities including hyponatremia and hyperkalemia. Addison's disease is an uncommon cause of hypercalcemia. We present a rare case of hypercalcemia in the setting of primary adrenal insufficiency.

Case Presentation: Our patient is 43-year-old Hispanic lady with no reported medical history who presented to the Emergency Room for evaluation of intractable nausea and vomiting of about a month duration. Clinical examination revealed a lethargic, dehydrated, and hypotensive lady. Initial laboratory findings revealed severe hypercalcemia of 15.4 mg/dl (N: 8.6-10.4). Serum AM Cortisol level was low < 0.5ug/dl ( N: 7-25ug/dl) and Adrenocorticotropic Hormone (ACTH) level was elevated 612 pg/ml ( N: 7.2-63.3pg/ml) confirming the diagnosis of Addison’s disease. However, laboratory investigations and imaging studies into other causes of hypercalcemia were unremarkable. She was admitted, rehydrated, placed on pressors, Calcitonin, Hydrocortisone and Fludrocortisone . Her symptoms improved with resolution of hypercalcemia.

Conclusion: Though rare, Addison’s disease should always be considered by physicians in the work up for hypercalcemia. This high index of suspicion improved the outcome in the management of this patient.

Presentation Type

Poster

Academic Level

Resident

Mentor/PI Department

Internal Medicine

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Severe Hypercalcemia: Unusual Life-threatening Presentation of Addison’s Disease

Background: Addison’s Disease, also known as primary adrenal insufficiency, is a rare disorder of the adrenal gland typically characterized by the combination of cortisol and mineralocorticoid deficiencies in addition to electrolyte abnormalities including hyponatremia and hyperkalemia. Addison's disease is an uncommon cause of hypercalcemia. We present a rare case of hypercalcemia in the setting of primary adrenal insufficiency.

Case Presentation: Our patient is 43-year-old Hispanic lady with no reported medical history who presented to the Emergency Room for evaluation of intractable nausea and vomiting of about a month duration. Clinical examination revealed a lethargic, dehydrated, and hypotensive lady. Initial laboratory findings revealed severe hypercalcemia of 15.4 mg/dl (N: 8.6-10.4). Serum AM Cortisol level was low < 0.5ug/dl ( N: 7-25ug/dl) and Adrenocorticotropic Hormone (ACTH) level was elevated 612 pg/ml ( N: 7.2-63.3pg/ml) confirming the diagnosis of Addison’s disease. However, laboratory investigations and imaging studies into other causes of hypercalcemia were unremarkable. She was admitted, rehydrated, placed on pressors, Calcitonin, Hydrocortisone and Fludrocortisone . Her symptoms improved with resolution of hypercalcemia.

Conclusion: Though rare, Addison’s disease should always be considered by physicians in the work up for hypercalcemia. This high index of suspicion improved the outcome in the management of this patient.

 

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