Autoimmune adrenalitis in adolescents in Germany: a series of 4 cases.
Luise Pudig, Lorenz Greifoner, Marlene Dieke et al.
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Case in brief
Four adolescents aged 14–17 years were diagnosed with autoimmune adrenalitis at a German university children’s hospital. Presentations included fatigue, arterial hypotension, depressive symptoms and skin hyperpigmentation; one patient had acute kidney failure in association with an acute viral infection. At diagnosis, all had hyponatraemia, low serum cortisol and elevated adrenocorticotropic hormone. Adrenal-cortex autoantibodies confirmed the diagnosis in each case. Three diagnoses occurred within 18 months. The report highlights varied presentations and notes that delayed recognition can lead to life-threatening complications.
What made this case unusual
The clinical range extended from depressive symptoms to acute kidney failure associated with an acute viral infection, illustrating how varied the presentation was in this adolescent series.
Diagnostic / clinical pearl
In adolescents with unexplained fatigue and hyponatraemia, consider adrenal insufficiency and assess cortisol; the reported cases also had elevated adrenocorticotropic hormone and adrenal-cortex autoantibodies.
Why it matters
The authors suggest the clustering of three diagnoses within 18 months may indicate a potential increase in annual incidence among adolescents, but the case series does not establish a population-level trend.