Luca Foppiani, Christian Cascio, Paola Pesce, Giancarlo Antonucci
{"title":"Two Hurt More Than One: Severe Hyponatraemia and Rhabdomyolysis as Presenting Features of Addison's Disease.","authors":"Luca Foppiani, Christian Cascio, Paola Pesce, Giancarlo Antonucci","doi":"10.14712/18059694.2025.16","DOIUrl":null,"url":null,"abstract":"<p><p>Addison's disease (AD) is characterized by non-specific symptoms and electrolyte disorders, namely hyponatraemia and hyperkalaemia; rhabdomyolysis is uncommon. AD may manifest at onset with a life-threatening adrenal crisis which is triggered by stressful events. We describe the case of a young man who was hospitalized for severe myalgia and fatigue. Severe hypotonic hyponatraemia, rhabdomyolysis and hypotension were found; hormonal assessment unexpectedly revealed primary adrenal insufficiency. Saline infusion and intravenous hydrocortisone significantly improved the patient's condition and normalized sodium and muscle enzyme levels; thereafter, he was switched to oral steroid therapy. The autoimmune origin of AD was ascertained by the positivity of adrenal cortex autoantibodies and 21b-hydroxylase autoantibodies. The association of hyponatraemia and rhabdomyolysis may be the initial finding of an as yet unknown AD, which requires proper investigation and treatment.</p>","PeriodicalId":101400,"journal":{"name":"Acta medica (Hradec Kralove)","volume":"68 1","pages":"31-36"},"PeriodicalIF":0.0000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Acta medica (Hradec Kralove)","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.14712/18059694.2025.16","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
Abstract
Addison's disease (AD) is characterized by non-specific symptoms and electrolyte disorders, namely hyponatraemia and hyperkalaemia; rhabdomyolysis is uncommon. AD may manifest at onset with a life-threatening adrenal crisis which is triggered by stressful events. We describe the case of a young man who was hospitalized for severe myalgia and fatigue. Severe hypotonic hyponatraemia, rhabdomyolysis and hypotension were found; hormonal assessment unexpectedly revealed primary adrenal insufficiency. Saline infusion and intravenous hydrocortisone significantly improved the patient's condition and normalized sodium and muscle enzyme levels; thereafter, he was switched to oral steroid therapy. The autoimmune origin of AD was ascertained by the positivity of adrenal cortex autoantibodies and 21b-hydroxylase autoantibodies. The association of hyponatraemia and rhabdomyolysis may be the initial finding of an as yet unknown AD, which requires proper investigation and treatment.