Addison’s disease presenting as anorexia nervosa in a young man

Tobin, M V; Morris, A. I.

doi:10.1136/pgmj.64.758.953

Cited by 15 publications

(8 citation statements)

References 11 publications

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“…Similar to our case, Tobin et al 2 published a case of a 20-year-old man who presented with anorexia, vomiting and significant weight loss. He was initially diagnosed as having anorexia nervosa but, after presenting 1 month later with severe dehydration and hyponatraemia, was subsequently identified to have Addison's disease.…”

Section: Discussionsupporting

confidence: 86%

Anorexia nervosa: a mistaken diagnosis

2016

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Eating disorders in the form of anorexia and bulimia are becoming increasingly common in young adults and children. Most of the patients are initially seen by their general practitioner (GP) and it may take several months before the facts are pieced together and an underlying eating disorder is identified. However, other medical conditions, albeit rare, should be considered when assessing these young adults as potentially missing them can lead to devastating consequences. This case highlights how a 15-year-old girl who presented to her GP with a history suggestive of an eating disorder and had a body mass index below the 0.4th centile, in fact had classical symptoms and clinical signs of primary adrenal failure, or Addison's disease.

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Section: Discussionsupporting

confidence: 86%

Anorexia nervosa: a mistaken diagnosis

2016

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“…Patients with primary adrenal insufficiency develop the characteristic increased pigmentation related to hypersecretion of proopiomelanocortin-derived peptides, which may guide the diagnosis (31). A substantial subset of patients is diagnosed with psychiatric illness, in particular with anorexia nervosa (36,39). Most patients have undergone extensive and repeated clinical investigations including endoscopy and imaging.…”

Section: Clinical Presentationmentioning

confidence: 99%

EXTENSIVE EXPERTISE IN ENDOCRINOLOGY: Adrenal crisis

Allolio

2015

European Journal of Endocrinology

196

230

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Adrenal crisis is a life-threatening emergency contributing to the excess mortality of patients with adrenal insufficiency. Studies in patients on chronic replacement therapy for adrenal insufficiency have revealed an incidence of 5-10 adrenal crises/100 patient years and suggested a mortality rate from adrenal crisis of 0.5/100 patient years. Patients with adrenal crisis typically present with profoundly impaired well-being, hypotension, nausea and vomiting, and fever responding well to parenteral hydrocortisone administration. Infections are the major precipitating causes of adrenal crisis. Lack of increased cortisol concentrations during infection enhances pro-inflammatory cytokine release and sensitivity to the toxic effects of these cytokines (e.g. tumour necrosis factor alpha). Furthermore, pro-inflammatory cytokines may impair glucocorticoid receptor function aggravating glucocorticoid deficiency. Treatment of adrenal crisis is simple and highly effective consisting of i.v. hydrocortisone (initial bolus of 100 mg followed by 200 mg over 24 h as continuous infusion) and 0.9% saline (1000 ml within the first hour). Prevention of adrenal crisis requires appropriate hydrocortisone dose adjustments to stressful medical procedures (e.g. major surgery) and other stressful events (e.g. infection). Patient education is a key for such dose adjustments but current education concepts are not sufficiently effective. Thus, improved education strategies are needed. Every patient should carry an emergency card and should be provided with an emergency kit for parenteral hydrocortisone self-administration. A hydrocortisone pen would hold a great potential to lower the current barriers to hydrocortisone self-injection. Improved patient education and measures to facilitate parenteral hydrocortisone self-administration in impending crisis are expected to significantly reduce morbidity and mortality from adrenal crisis.

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“…Hyperpigmentation which affects the skin and mucosal surfaces is the most specific sign of chronic primary adrenal insufficiency, but its absence does not exclude this diagnosis. Addison's disease my be misdiagnosed as anorexia nervosa4 or depression 5…”

Section: Discussionmentioning

confidence: 99%

A young man with acute paraparesis

2000

Postgraduate Medical Journal

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Addison’s disease presenting as anorexia nervosa in a young man

Cited by 15 publications

References 11 publications

Anorexia nervosa: a mistaken diagnosis

Anorexia nervosa: a mistaken diagnosis

EXTENSIVE EXPERTISE IN ENDOCRINOLOGY: Adrenal crisis

A young man with acute paraparesis

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