SHM Converge Scientific Abstract ePoster Gallery-End-Stage Renal Disease Complications Masking Diagnosis of Addison's Disease

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This case report describes a 61-year-old African-American man with end-stage renal disease who was admitted with altered mental status and recurrent hypoglycemia shortly after AV graft placement for dialysis access. Because his symptoms overlapped with other possible causes, including subclavian steal syndrome and complications of ESRD, the initial focus was on vascular and neurologic evaluation. Brain imaging was unremarkable, blood cultures were negative, and hypoglycemia persisted despite dextrose support. He later developed hypovolemic shock, prompting endocrine evaluation and an ACTH stimulation test, which confirmed Addison’s disease (primary adrenal insufficiency).<br /><br />The report highlights how Addison’s disease can be difficult to recognize because it often presents gradually with nonspecific symptoms such as fatigue, weakness, weight loss, hypotension, abdominal complaints, and hypoglycemia. In patients with darker skin tones, classic hyperpigmentation may be less obvious, further delaying diagnosis. ESRD can also mask or mimic adrenal insufficiency, making recognition even more challenging.<br /><br />Once diagnosed, the patient improved after treatment with IV hydrocortisone and oral fludrocortisone, with recovery of blood pressure and blood glucose. The case emphasizes the importance of considering Addison’s disease earlier in patients with unexplained altered mental status and hypoglycemia, especially when standard workup is unrevealing. It also stresses the need for better awareness and communication between specialties to avoid delayed diagnosis, prolonged hospitalization, ICU admission, and potentially life-threatening Addisonian crisis.

Asset Subtitle

Katrina Villavert

Meta Tag

Author List Ceyda Zarifi, Daria Nahidipour, Gabriel Consunji, Katrina Villavert, Michael Darabos

Category Clinical Vignettes

Concept Primary Adrenal Insufficiency

Concept Adrenal Crisis

Concept Hypotension

Concept Hypoglycemia

Concept Altered Mental Status

Distinguished Non-Finalist

Presenter Organization University of California, Riverside School of Medicine

Presenting Author Katrina Villavert

Track Adult

Keywords

Addison's disease

primary adrenal insufficiency

hypoglycemia

altered mental status

end-stage renal disease

AV graft placement

hypovolemic shock

ACTH stimulation test

hydrocortisone

fludrocortisone

Primary Adrenal Insufficiency

Adrenal Crisis

Hypotension

Hypoglycemia

Altered Mental Status