Relative Adrenal insufficiency masquerading hypothyroidism 2907-2909
Dr. Shrenik Doshi,(M.D.) (Medicine)
56/2 Paras Society 2,Near Panchvati,Jamnagar - 361002,
Ph:(0288)2558984, +919979859397, +918000385393
E mail: email@example.com
A 35 year old male presented with complaints of generalized weakness, easy fatigability and low grade fever for the past 6 months. His past, personal and family history was unremarkable. On examination, his temperature was found to be normal, his pulse was 108/min regular and his blood pressure was 98/60 mmHg in the supine posture, with a fall of 20 mm Hg on standing. Oral examination revealed brownish-black pigmentation over the palate, the buccal mucosa and the palmer crease. The respiratory and the cardiovascular system examinations were normal. Investigations revealed haemoglobin of 8 gm% with other normal parameters; normal liver and renal function tests; serum HIV was non-reactive; serum electrolytes were normal; electrocardiogram was suggestive of sinus tachycardia; chest x-ray was normal; Abdominal ultrasonography was unremarkable and Computerized Tomogram of the Adrenal glands was normal. Serum thyroid stimulating hormone was 20.9 mcg/ml, S Free T4 was 1.2 ng/dl, anti-thyroid Peroxidase antibody was negative and serum cortisol (fasting 8 AM) was 12.0 mcg/dl. The Insulin Tolerance test failed to stimulate cortisol production and hence, the patient was diagnosed as having relative adrenal insufficiency. On treatment with physiological doses of corticosteroids, the patient improved remarkably and his thyroid function test returned to normal within a month.