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Atypical Presentation of Adrenocortical Insufficiency with Anorexia and Jaundice

Challenging differential diagnosis

Xiang-Xing Li, Jie Liu, You-Lian Chen, Guang-Jian Chen, Zhen-Yu Wang, Jun-Jun Zhu, Yun-Wei Guo, Xiu-Qing Wei

Department of Gastroenterology, Yuedong Hospital of the Third Affiliated Hospital of Sun Yat-sen University, Meizhou, Guangdong, China (mainland)

Am J Case Rep 2018; 19:705-709

DOI: 10.12659/AJCR.909190

Available online:

Published: 2018-06-18

BACKGROUND: Adrenal insufficiency is mainly due to insufficient adrenal corticosteroid hormones secretion by the adrenal cortex, which leads to clinical manifestations such as weakness, weight loss, hyperpigmentation, hypotension, and vomiting. However, the clinical manifestations of adrenocortical insufficiency may be atypical: anorexia, ascites, impaired liver function, and alacrima have been reported. Jaundice and anorexia presenting together in the same patient as the main symptoms are rare.
CASE REPORT: We present a rare case of a 65-year-old woman diagnosed as having adrenocortical insufficiency with chief complaints of anorexia and jaundice. The patient had a history of hiatus hernia and gastroesophageal reflux disease, which can easily lead to a misdiagnosis in clinical practice, which is what happened with this patient at the beginning in our hospital and in the other hospitals that treated her previously. Hiatus hernia was considered the mostly likely cause of her vomiting, and a laparotomy was done to repair the hernia at the local hospital. However, there was no improvement. After regular glucocorticoid replacement, the patient’s symptoms all soon disappeared.
CONCLUSIONS: Adrenal insufficiency can atypically present as anorexia and jaundice. In order to avoid misdiagnosis, physicians should pay attention to these atypical symptoms.

Keywords: adrenal insufficiency, Anorexia, Jaundice