Clinical Chemistry - Case Study

An Unusual Presentation of Autoimmune Primary Adrenal Insufficiency


An 8-year-old boy presented to the emergency department with Kussmaul breathing, fever, and vomiting. He was confirmed positive for SARS-CoV-2 by polymerase chain reaction testing, having been a close contact of a known case. Further history, however, revealed a 1-week history of polyuria, polydipsia, and recent unintentional weight loss. There was no history of diarrhea.
His past medical history was unremarkable. His mother had type 1 diabetes mellitus (T1D) but there was no other history of autoimmune disorders in his family.
On examination, he was tachycardic (heart rate 148 bpm), tachypnoeic (respiratory rate 40 breaths per minute), and hypertensive (blood pressure 151/94 mmHg). He was given a 10 mL/kg bolus of 0.9% saline by first responders. He otherwise had an unremarkable cardiovascular, respiratory, and abdominal examination with no evidence of hyperpigmentation.