A case report of central adrenal insufficiency: hiding in persistent, refractory nausea and vomiting

Abstract

Abstract Background Central adrenal insufficiency (CAI) is defined as the inability of the adrenal glands to release sufficient corticosteroids due to a series of diseases or injuries of the hypothalamus or pituitary. Signs and symptoms of CAI are insidious, ambiguous, and debilitating. Preceding studies suggest that elderly patients with CAI may present with hyponatremia as a characteristic manifestation, but little is mentioned about gastrointestinal (GI) symptoms. Herein we report a rare case of an elderly male patient with a radio-chemotherapy history for nasopharyngeal carcinoma, in whom prolonged exogenous glucocorticoid replacement and infectious stress from two bouts of bacterial pneumonia combined to cause severe CAI with prodromal symptoms of persistent, intractable nausea and vomiting. Case presentation A 71-year-old man presented to the gastroenterology department with persistent nausea and vomiting. Gastroscopy, brain magnetic resonance imaging (MRI), and contrast-enhanced abdominal computed tomography (CT) were performed to exclude organic lesions. The diagnosis of CAI was confirmed by checking the levels of basal cortisol and adrenocorticotropic hormone. After replacement therapy with hydrocortisone, the patient's GI symptoms resolved rapidly, hyponatremia was corrected. At subsequent follow-ups, he was doing well with no hospitalizations. Conclusion CAI in elderly patients can start with persistent, refractory nausea and vomiting, and is featured by uncorrectable and insidious hyponatremia. Timely hydrocortisone replacement therapy averts life-threatening adrenal crises.