A Case of Acute Adrenal Insufficiency: A Rare but Possible Cause of Hypercalcemia

Abstract

A 30-year-old woman presented with a 15-day history of epigastric pain, nausea, vomiting, asthenia, and weight loss. On admission, hypercalcemia was reported with a negative etiologic workup (including no primary hyperparathyroidism, malignancy, or vitamin D toxicity). Fluid replacement did not improve her hypercalcemia. We performed a blood ionogram and assessed the adrenocortical function, which showed that her serum cortisol was decreased, her adrenocorticotropic hormone (ACTH) was elevated, and anti-21 hydroxylase antibodies were positive. We established the diagnosis of autoimmune primary acute adrenal insufficiency. The patient was treated with hydrocortisone. Shortly after initiating the treatment, her serum calcium levels returned to normal and her symptoms improved. This case report highlights the fact that even though adrenal insufficiency is an uncommon etiology of hypercalcemia, it should not be totally ignored, especially since hypercalcemia can sometimes be indicative of adrenal impairment.

Addison’s Disease: Diagnosis and Management Strategies

“…26 Another forgotten presentation of AD amid an adrenal crisis is hypercalcemia. 27 All these interesting cases we classified as the subsection dedicated to AD awareness due to clinical presentation include 17 case reports (each of a single case), a case series of 3 cases and one study of 26 patients, a total of 40 subjects. As mentioned, prompt recognition might be lifesaving, and the traditional picture of presentation might not be enough (Table 1).…”