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Reminder of important clinical lesson
CASE REPORT
Hyponatraemia and hyperpigmentation in primary adrenal insufficiency
  1. Bernadette Johanna Maria Benner,
  2. Jelmer Alsma and
  3. Richard A Feelders
  1. Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
  1. Correspondence to Bernadette Johanna Maria Benner, bjbenner{at}live.nl

Abstract

Hyponatraemia is a common electrolyte disturbance with multiple causes. We present a case of a 49-year-old Caucasian female with cholangiocarcinoma, who had a hyponatraemia which was initially assumed to be based on a syndrome of inappropriate antidiuretic hormone secretion as paraneoplastic phenomenon. At physical examination, hyperpigmentation was seen and multiple episodes with syncope were reported. Subsequent endocrine assessment with a synthetic adrenocorticotropin hormone (ACTH) stimulation test and measurement of ACTH levels revealed primary adrenal insufficiency also known as Morbus Addison. We started hydrocortisone and fludrocortisone replacement therapy, resulting in resolving of symptoms, hyponatraemia and hyperpigmentation.

  • adrenal disorders
  • pancreatic cancer
  • thyroiditis

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bcr-2018-227200

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    Footnotes

    • Contributors The manuscript has been approved by all authors and has never been published, is not under consideration in the similar form in any other peer-reviewed media. To the best of our knowledge, all aspects of our work has been written with accuracy and no conflict of interest, financial or other, exists. Detailed author contributorship statement: BJMB; corresponding author, initiated the case for a case report together with JA. Together with JA and RAF, the design of the paper was established. BJMB conducted and revised the paper, generated laboratory results and patient information data from our patient information system, made pictures of the hands and collected patients approval. JA; initiated the case for a case report together with BJMB. Together with BJMB and RAF, the design of the paper was established. Alsma provided analysis and interpretation of data, revised different concepts of the paper critically and has given his final approve before publishing. RAF; established together with BJMB and JA, the design of the paper. RAF provided analysis and interpretation of data, revised different concepts of the paper critically and has given his final approve before publishing.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Obtained.