Case report: Atypical presentation of adrenal insufficiency: 13 year old presented with vomiting (one day), lethargy two weeks. mild dehydration, vitals stable, generally healthy, examination unremarkable, medication nill, history of insect bite two weeks ago, no allergies, started on I. V maintenance fluids, investigations (blood) normal, the only abnormal was low soduim, normal glucose and potassium, soduim was 122 mol/l, repeated soduim was 119 after the maintain ace 0.9% normal saline 3% soduim was added to the maintanance to correct the soduim fluid was restricted to 60% because of SIADH repeated was not improving short synecthen showed no response to cortisol the child was started on hydrocortisone with full maintenance iv fluids the repeated soduim was coming back to normal auto adrenal antibodies were negative ACTH was normal, renin was normal. MRI brain showed small pineal cyst as incidental finding serum osmolality normal, no pigmentation noted child Blood pressure was normal.
Conclusion: Initial impression was gastro. Despite replacement of fluids the soduim was not responding in 30% of case potassium can be normal his 17OHP was normal genitic studies were normal our impression was adrenal insufficieny secondary to? Allergic reaction to insect bite the child is followed up on maintanance dose of hydrocortisone and advice for stress dose.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology