iatroX Rounds #9
The clues
- 1
A 34-year-old woman presents to her GP with a six-month history of worsening fatigue, lethargy, and generalised weakness.
- 2
She has noticed unintentional weight loss and occasional nausea, alongside strange cravings for very salty foods.
- 3
She has a background of vitiligo and autoimmune hypothyroidism, for which she takes levothyroxine.
- 4
On examination, her blood pressure is 95/60 mmHg with a significant postural drop. There is also noticeable hyperpigmentation in the palmar creases and buccal mucosa.
- 5
Initial blood tests reveal a serum sodium of 128 mmol/L and a serum potassium of 5.6 mmol/L, with a random morning cortisol level of 90 nmol/L.
- 6
A Short Synacthen test is performed, which shows a baseline cortisol of 85 nmol/L and a 30-minute cortisol level of 110 nmol/L.
Addison's disease is primary adrenal insufficiency typically caused by autoimmune destruction of the adrenal cortex in the UK. The resulting deficiency in cortisol and aldosterone leads to systemic symptoms, hypotension, and electrolyte disturbances.
- Hyperpigmentation of skin creases and mucous membranes
- Postural hypotension and salt craving
- Hyponatraemia and hyperkalaemia
- Association with other autoimmune conditions like vitiligo or type 1 diabetes
for education and entertainment. not medical advice.