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Revista de la Asociación Médica del Centro Médico ABC

2013, Number 2

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An Med Asoc Med Hosp ABC 2013; 58 (2)

Addison’s disease. A case report

Álvarez II, Rivera EM, Luna SRA, Antillón FC

Language: Spanish
References: 12
Page: 132-136
PDF size: 94.47 Kb.


ABSTRACT

Addison’s disease is rare in the pediatric population and is characterized by general fatigue, weakness, hyperpigmentation, hypoglycemia with ketosis, hyponatremia and hyperkalemia. Autoimmune destruction of the suprarrenal glands is responsible for about 80% of AD cases in adults, and in children over two years. We present the case of an 11 year old boy with a five month history of general fatigue, dizziness, weight loss of 3.5 kg; that progressed to poor general condition, vomiting and dehydration. On admission he presented hyponatremia (107 mEq/L), hyperkalemia (5.7 mEq/L), hypochloremia (76 mEq/L), and in morning serum cortisol 0.67 µg/dL (5-25 µg/dL) and ACTH of 1,165 pg/mL (9-57 pg/mL). Adrenal insufficiency was then diagnosed and started on hydrocortisone and fludrohidrocortisone, after 48 hours there was clinical improvement and increased serum sodium values with normal potassium levels. It’s imperative to do a good medical history, physical examination and accurate laboratory tests for early diagnosis and successful treatment. The association of fatigue, weakness, gastrointestinal symptoms, hypotension, hyponatremia, hyperkalemia and hyperpigmentation, should make us think of primary adrenocortical insufficiency.


REFERENCES

  1. Candel FJ, Matesanz M, Candel I. Insuficiencia corticosuprarenal primaria. Enfermedad de Addison. Ann Med Interna. 2001; 18: 492-498.

  2. Ulate A, Jaramillo O. Enfermedad de Addison en una gemela de 19 meses. Acta Pediátr Costarric. 2009; 21: 47-51.

  3. Shulman D, Palmert MR, Kemp SF. Lawson Wilkins Drugs and Therapeutics Committee. Adrenal Insufficiency: still a cause of morbidity and in childhood. Pediatrics. 2009; 119: 484-494.

  4. August GP. Consultation with the specialist: treatment of Adrenocortical Insufficiency. Pediatr Rev. 1997; 18: 59-62.

  5. Ten S, New M, Maclaren N. Clinical Review 130: Addison’s disease 2001. J Clin Endocrinol Metab. 2001; 86: 2909-2920.

  6. Erichsen M, Lovas K, Fougner K, Svartberg J, Hauge E, Bollerslev J et al. Normal overall mortality rate in Addison’s disease, but young patients are at risk of premature death. Eur J Endocrinol. 2009; 160: 233-237.

  7. Hsieh S, White P. Presentation of primary adrenal insufficiency in childhood. J Clin Endocrinol Metab. 2011; 96: 925-928.

  8. Velasco R, Pavía C, Valls C, Pueyo MJ. Enfermedad de Addison en la infancia: Nuestra experiencia. Act Ped Esp. 1995; 53: 8-10.

  9. Kasperlik A, Migdalska B, Czarnocka B, Drac J, Niegowska E, Czech W. Association of Addison’s disease with autoimmune disorders-a long term observation of 180 patients. Postgrad Med J. 1991; 67: 984-987.

  10. Perry R, Kecha O, Paquette J, Huot C, Van Vliet G, Deal C. Primary Adrenal insufficiency in children: twenty years of experience at the Sainte-Justine Hospital, Montreal. J Clin Endocrinol Metab. 2005; 90: 3243-3249.

  11. Cogan MG. Sodium disturbances In: Fluid and electrolytes physiology and pathophysiology. San Francisco: Appleton and Lange; 1993: 115-25.

  12. Stefan G. Kiessling. Trastornos del balance hídrico y del sodio. En: Nefrología Pediátrica en cuidado intensivo. Colombia: Distribuidora Editorial Médica; 2012: 14-17.




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