Renal involvement in adrenal insufficiency (Addison disease): can we always recognize it?

Fofi, Claudia; Maresca, Barbara; Altieri, S; Menè, Paolo; Festuccia, Francescaromana

doi:10.1007/s11739-019-02209-x

Cited by 9 publications

(13 citation statements)

References 36 publications

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“…Tuberculosis (TB) was the most common cause of Addison's disease. However, with the advent of effective medication for TB, autoimmune causes are currently considered to be the most common etiology [ 3 ]. Adrenal insufficiency does not manifest until 90% of the gland has been destroyed or atrophied as seen in imaging.…”

Section: Discussionmentioning

confidence: 99%

“…Acute adrenal crisis is a life-threatening presentation of Addison's disease seen in as many as 25% of the patients [ 3 ]. Acute renal failure as a presenting symptom is extremely rare with an incidence of 6% reported in the literature [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…Hyperkalemic paralysis with acute renal failure can be a very misleading presentation of Addison's disease as the life-threatening hyperkalemia can be misdiagnosed as a consequence of the kidney injury. Very few cases in the literature have so far been reported where acute renal failure was the presenting manifestation of primary adrenal insufficiency [ 1 – 3 ]. Here, we present such a case of a young 37-year-old male who came in with acute flaccid paralysis secondary to life-threatening hyperkalemia and acute renal failure.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Addison’s Disease Presenting as Acute Renal Failure and Hyperkalemic Paralysis: A Rare Presentation

Jana

Janga

Greenberg

et al. 2021

Case Reports in Endocrinology

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Hyperkalemic paralysis in the setting of acute renal failure can lead to a missed or delayed diagnosis of adrenal insufficiency as the raised potassium can be attributed to the renal failure. Acute kidney injury as the presenting manifestation in an adrenal crisis due to Addison’s disease has been rarely reported in the literature. Here, we present the case of a young 37-year-old male who came with hyperkalemic paralysis and acute renal failure needing emergent hemodialysis. He had no past medical history and no medication history. His hyponatremia, hypotension, and hyperkalemia pointed to a picture of adrenal insufficiency confirmed by undetectable serum cortisol, elevated ACTH, renin, and low aldosterone levels and imaging. Replacement steroid therapy was given, and the patient made a steady recovery. He was advised on the importance of compliance to treatment at discharge to prevent another crisis event. Acute renal failure with hyperkalemia as a presenting manifestation of Addison’s disease can be very misleading. It is especially important to be vigilant of adrenal insufficiency in such patients as the hyperkalemia is resistant to standard therapy of insulin dextrose and can precipitate fatal arrhythmia if treatment is delayed.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Addison’s Disease Presenting as Acute Renal Failure and Hyperkalemic Paralysis: A Rare Presentation

Jana

Janga

Greenberg

et al. 2021

Case Reports in Endocrinology

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“…Se considera que al menos el 90% de la corteza adrenal se debe haber destruido para evidenciar dichas manifestaciones, sumada a la velocidad de destrucción del tejido. 6 Al referirnos a adrenalitis, se habla del proceso inflamatorio de las glándulas suprarrenales que pueden asociarse o no con destrucción de estas y que en la actualidad se considera secundaria a autoinmunidad; mientras que el término de adrenalitis por TBC hace referencia al proceso inflamatorio secundario a la diseminación hematógena. 7…”

Section: Definiciónunclassified

“…Como se tiende a medir los niveles de cortisol total, estados como el embarazo, la administración de estrógenos orales y el hipertiroidismo pueden aumentar la presencia de la globulina fijadora de cortisol (CBG) o albúmina, lo que conlleva a un aumento facticio del valor registrado, y estados como cirrosis, síndrome nefrótico, hipotiroidismo o sepsis pueden disminuirlo incurriendo en errores de interpretación y diagnóstico. 1 En general, valores >20 mcg/ dL (550 nmol/L) excluyen el diagnóstico y <5 mcg/dL (138 nmol/L) confirman la IA con una sensibilidad de 36% pero especificidad de 100% 11 , en muestras por la mañana o estados de estrés 6,11 , mientras que para los valores intermedios o zona gris se realizarán pruebas confirmatorias. Además la medición de niveles de ACTH con valores dos veces sobre el límite superior sugieren también el diagnóstico.…”

Section: Diagnósticounclassified

Adrenalitis tuberculosa: a propósito de una actualización

2021

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Introducción: la insuficiencia suprarrenal primaria (IA) descrita por Thomas Addison en 1855 atribuía como principal causa a la infección por tuberculosis (TBC) diseminada, pero con el paso del tiempo ha disminuido en los países desarrollados. En aquellos en vías de desarrollo se mantiene alta esta etiología infecciosa, en especial en pacientes con VIH. Objetivo: realizar una revisión narrativa de la literatura reciente sobre la adrenalitis TBC, incluyendo el enfoque, manejo y seguimiento en los casos de insuficiencia suprarrenal primaria (IA). Materiales y métodos: búsqueda y análisis de los artículos disponibles en los últimos 5 años bajo los descriptores en ciencias de la salud (DeCS) enfermedad de Addison, tuberculosis, insuficiencia suprarrenal primaria y adrenalitis en español en las bases de Google scholar y LILACS, y en inglés en PubMed y ClinicalKey. Conclusiones: la insuficiencia adrenal o adrenalitis por TBC ha descendido como causa de IA primaria, pero en el contexto de reemergencia de infección por VIH, continúa siendo una causa importante de IA en países en desarrollo. En estos casos además de la suplencia con corticosteroides el tratamiento de la causa específica es de importancia para impactar en la respuesta clínica, la supervivencia y la calidad de vida.

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Addison’s Disease Along with Hyperkalemic Periodic Paralysis and Acute Renal Failure Misinterpreted as Peripheral Motor Neuropathy

Malik

Hameed²

2023

The Misdiagnosis Casebook in Clinical Medicine

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Renal involvement in adrenal insufficiency (Addison disease): can we always recognize it?

Cited by 9 publications

References 36 publications

Addison’s Disease Presenting as Acute Renal Failure and Hyperkalemic Paralysis: A Rare Presentation

Addison’s Disease Presenting as Acute Renal Failure and Hyperkalemic Paralysis: A Rare Presentation

Adrenalitis tuberculosa: a propósito de una actualización

Addison’s Disease Along with Hyperkalemic Periodic Paralysis and Acute Renal Failure Misinterpreted as Peripheral Motor Neuropathy

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