Beyond Hyponatremia: Unmasking Addison's Disease
https://doi.org/10.15605/jafes.041.S1
- Author:
Aminath Naqsha
1
;
Ilham Ismail
2
;
Mahrunissa Mahadi
2
;
Yik Hin Chin
2
;
K.J. Lingeswary Krishnan
2
;
Norlaila Mustafa
1
;
Norasyikin A. Wahab
2
Author Information
1. Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia; Department of Medicine, Hospital Canselor Tuanku Muhriz
2. Department of Medicine, Hospital Canselor Tuanku Muhriz
- Publication Type:Journal Article
- MeSH:
Hyponatremia
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):29-
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Primary adrenal insufficiency is rare and potentially lifethreatening, with an estimated prevalence of five cases per
million in Southeast Asia. Local data remain limited, and
diagnosis is frequently delayed due to non-specific clinical
manifestations. Widespread use of traditional medication in
Malaysia may further undermine recognition, particularly
when steroid exposure is concealed. We report a female on prolonged use of traditional remedies presented with
classic features of Addison’s disease rather than cushingoid
features, confirmed by biochemical results.
Case:A 65-year-old female with underlying dyslipidemia and
osteoarthritis presented with 4 days of giddiness, poor
intake, nausea, and diarrhea. Further history revealed
prolonged use of multiple traditional Chinese medicines,
discontinued months prior, raising suspicion of prior
steroid exposure. She claimed her skin has become
darker over the past 2 months. She denied any infectious
symptoms, contact with PTB patients, or exposure to
birds. There was no family history of autoimmune disease.
Clinically, she was dehydrated and hypotensive. Her blood
pressure improved after fluid resuscitation. There was
hyperpigmentation involving the face, extremities, tongue,
and buccal mucosa.
Investigation results showed severe hyponatremia (119
mmol/L), hyperkalemia (4.93 mmol/L), with normal
creatinine and negative infective markers. Hyponatremia
persisted despite adequate hydration. Thyroid function test
was normal (Free T4 12.28 pmol/L and thyroid-stimulating
hormone 4.16 µIU/mL). Morning cortisol was suppressed
(37 nmol/L) with markedly elevated adrenocorticotropic
hormone levels (1,134 pg/mL), confirming the diagnosis of
primary adrenal insufficiency. Hence, hydrocortisone was
commenced, and serum sodium was normalized 2 days
later. The underlying etiology remains under evaluation,
although autoimmune adrenalitis is the most likely cause.
Conclusion:Primary adrenal insufficiency should be considered in
patients presenting with unexplained hyponatremia and
hypotension. In a setting where traditional medication use
is prevalent, unrecognized steroid exposure may further
complicate diagnosis. A thorough clinical and appropriate
biochemical assessment is crucial to differentiating primary
from secondary adrenal insufficiency.
- Full text:2026072814071963888EP_A020.pdf
