We report the case of a 21-year-old male patient, without known allergies or other antecedents, who came to the emergency department for a 6-month clinical picture of asthenia, increased fatigue with moderate exercise and 10 kg in general syndrome.
Due to episodes of pain in this period, the patient came twice to the Emergency Department and underwent an informed gastroscopy of minimal hitricate hernia grade I and biliary reflux.
In the last 5 days, the symptoms are exacerbated, with vomiting, more intense diffuse abdominal pain and liquid stools without increasing the number of them.
Physical examination revealed a blood pressure of 120/60 mmHg, heart rate of 110m, tender abdomen, conscious and oriented, without focal, eupneic, cardiac frequency of 110m, auscultation revealed no tender mass, tenderness or tenderness.
Generalized cutaneous hyperpigmentation, accentuated in the nipples, genital area and melanotic spots in the palate and gingival edges are noteworthy.
Blood tests at admission showed a blood glucose of 59 mg/dL, creatinine 4.32 mg/dL, urea 214 mg/dL, Na 123 mg/dL, K 8.0 mg/dL, Ca 8.2 mg/dL bicarbonate O2
The hemogram showed hemoglobin of 13.4 g/dl, hematocrit 39.5%, MCV 83 fL, leukocytes 12800 (45% neutrophils, 32% lymphocytes, 12% monocytes and 10.5% eosinophylls).
Coagulation was normal.
The electrocardiogram showed sinus tachycardia at 110 bpm with RSR' configuration and QT prolongation (487 ms).
The chest X-ray was normal.
During his stay in the emergency department, measures are initiated for the correction of hyperkalaemia but the patient is progressively more sweaty, tachycardic (500 mg continuous infusion), being able to start with a bolus of 24 mg intravenous infusion (100 mg).
Blood samples taken prior to initiation of corticoid therapy for determination of adrenal function showed basal cortisol 4.0 mg/dL and plasma ACTH 264 pg/ml.
The determination of anti-adrenal capsule antibodies in serum by indirect imnufluorescence was positive with a title of 1
Determination of thyrotropin, free thyroxine, FSH and LH, as well as antithyroglobulin and microsomal antiperoxidase antibodies were within normal ranges.
Abdominal CT: presence of morphologically normal adrenal glands.
The patient was discharged from the intensive care unit 3 days after admission and from the hospital 7 days after admission with analytical parameters of renal function and within normal limits with treatment with hydroalcoholic acid 8 hrs.
