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Young Patient With Multiple Autoimmune Diseases
- A 21-year-old man with Hashimoto's and celiac had months of weakness, orthostatic dizziness, nausea, and weight loss prompting adrenal workup.
- He reported persistent tanning and salt cravings that led clinicians to note mucosal hyperpigmentation on exam.
Physiology Explains Symptoms
- Cortisol supports vascular tone, glycemic control, mood, and general wellbeing so its deficiency causes fatigue, anorexia, weight loss and hypotension.
- Mineralocorticoid loss causes volume depletion, orthostasis, hyperkalemia and salt cravings due to impaired renal sodium reabsorption.
Primary Versus Secondary Causes
- Distinguish primary from secondary adrenal insufficiency by ACTH: high ACTH indicates primary adrenal failure while low or inappropriately normal ACTH suggests secondary cause.
- Primary causes include autoimmune destruction, infection, hemorrhage, metastases, and drugs that inhibit steroid synthesis.