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First presentation of Addison's disease as hyperkalaemia in acute kidney injury
  1. Sara Maki1,
  2. Caroline Kramarz1,
  3. Paula Maria Heister2,
  4. Kamran Pasha1,2
  1. 1Department of Acute Medicine, Hillingdon Hospital, Uxbridge, UK
  2. 2Imperial College London, London, UK
  1. Correspondence to Dr Kamran Pasha, Muhammad.Pasha{at}


Addison's disease is a rare endocrine disorder that frequently presents with non-specific symptoms, but may deteriorate rapidly into life-threatening Addisonian crisis if left untreated. Diagnosis can be difficult in patients without a suggestive medical history. We describe a case of a 37-year-old man who was admitted with acute kidney injury and hyperkalaemia, resistant to treatment with insulin/dextrose and calcium gluconate. On clinical examination, he was found to be hyperpigmented; a subsequent random serum cortisol of 49 nmol/L affirmed the preliminary diagnosis of Addison's disease. The patient's hyperkalaemia improved on treatment with hydrocortisone, and a follow-up morning adrenocorticotropic hormone of 1051 ng/L confirmed the diagnosis.

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