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Recurrent nocturnal hypoglycaemia as a cause of morning fatigue in treated Addison’s disease – favourable response to dietary management: a case report

BACKGROUND: Addison’s disease, or primary adrenal insufficiency, is often associated with reduced well-being and fatigue despite use of currently recommended adrenal hormone replacement. Hypoglycaemia is a known manifestation of glucocorticoid deficiency, but is generally considered rare in adults a...

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Autores principales: Petersen, Kristina S, Rushworth, R. Louise, Clifton, Peter M, Torpy, David J
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4619326/
https://www.ncbi.nlm.nih.gov/pubmed/26500000
http://dx.doi.org/10.1186/s12902-015-0058-6
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author Petersen, Kristina S
Rushworth, R. Louise
Clifton, Peter M
Torpy, David J
author_facet Petersen, Kristina S
Rushworth, R. Louise
Clifton, Peter M
Torpy, David J
author_sort Petersen, Kristina S
collection PubMed
description BACKGROUND: Addison’s disease, or primary adrenal insufficiency, is often associated with reduced well-being and fatigue despite use of currently recommended adrenal hormone replacement. Hypoglycaemia is a known manifestation of glucocorticoid deficiency, but is generally considered rare in adults and not relevant to troubling ongoing symptoms in patients with Addison’s disease. CASE PRESENTATION: A 43 year old woman with a three year history of Addison’s disease complained of severe morning fatigue and headaches, despite standard glucocorticoid replacement therapy in the form of thrice daily hydrocortisone and mineralocorticoid replacement with fludrocortisone. Alternative glucocorticoid replacement regimens and the addition of dehydroepiandrosterone replacement therapy had no effect. Nocturnal hypoglycaemia was suspected and a 4-day continuous glucose monitor system (CGMS) revealed hypoglycaemia (interstitial glucose < 2.2 mmol/L) between 0200–0400 h on 3 of 4 days. The patient was counselled to take an evening snack designed to ensure slow absorption of ingested carbohydrates. Nocturnal hypoglycaemia was then absent on follow up CGMS assessment. The patient noted a marked symptomatic improvement in morning symptoms, but with persistent fatigue during the day. CONCLUSION: Currently, the best strategy for control of non-specific symptoms in treated Addison’s disease is unknown, but it may be that investigation for hypoglycaemia and treatment, where necessary, could assist some sufferers to achieve improved wellbeing. A systematic study of this phenomenon in Addison’s disease is required.
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spelling pubmed-46193262015-10-26 Recurrent nocturnal hypoglycaemia as a cause of morning fatigue in treated Addison’s disease – favourable response to dietary management: a case report Petersen, Kristina S Rushworth, R. Louise Clifton, Peter M Torpy, David J BMC Endocr Disord Case Report BACKGROUND: Addison’s disease, or primary adrenal insufficiency, is often associated with reduced well-being and fatigue despite use of currently recommended adrenal hormone replacement. Hypoglycaemia is a known manifestation of glucocorticoid deficiency, but is generally considered rare in adults and not relevant to troubling ongoing symptoms in patients with Addison’s disease. CASE PRESENTATION: A 43 year old woman with a three year history of Addison’s disease complained of severe morning fatigue and headaches, despite standard glucocorticoid replacement therapy in the form of thrice daily hydrocortisone and mineralocorticoid replacement with fludrocortisone. Alternative glucocorticoid replacement regimens and the addition of dehydroepiandrosterone replacement therapy had no effect. Nocturnal hypoglycaemia was suspected and a 4-day continuous glucose monitor system (CGMS) revealed hypoglycaemia (interstitial glucose < 2.2 mmol/L) between 0200–0400 h on 3 of 4 days. The patient was counselled to take an evening snack designed to ensure slow absorption of ingested carbohydrates. Nocturnal hypoglycaemia was then absent on follow up CGMS assessment. The patient noted a marked symptomatic improvement in morning symptoms, but with persistent fatigue during the day. CONCLUSION: Currently, the best strategy for control of non-specific symptoms in treated Addison’s disease is unknown, but it may be that investigation for hypoglycaemia and treatment, where necessary, could assist some sufferers to achieve improved wellbeing. A systematic study of this phenomenon in Addison’s disease is required. BioMed Central 2015-10-24 /pmc/articles/PMC4619326/ /pubmed/26500000 http://dx.doi.org/10.1186/s12902-015-0058-6 Text en © Petersen et al. 2015 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Case Report
Petersen, Kristina S
Rushworth, R. Louise
Clifton, Peter M
Torpy, David J
Recurrent nocturnal hypoglycaemia as a cause of morning fatigue in treated Addison’s disease – favourable response to dietary management: a case report
title Recurrent nocturnal hypoglycaemia as a cause of morning fatigue in treated Addison’s disease – favourable response to dietary management: a case report
title_full Recurrent nocturnal hypoglycaemia as a cause of morning fatigue in treated Addison’s disease – favourable response to dietary management: a case report
title_fullStr Recurrent nocturnal hypoglycaemia as a cause of morning fatigue in treated Addison’s disease – favourable response to dietary management: a case report
title_full_unstemmed Recurrent nocturnal hypoglycaemia as a cause of morning fatigue in treated Addison’s disease – favourable response to dietary management: a case report
title_short Recurrent nocturnal hypoglycaemia as a cause of morning fatigue in treated Addison’s disease – favourable response to dietary management: a case report
title_sort recurrent nocturnal hypoglycaemia as a cause of morning fatigue in treated addison’s disease – favourable response to dietary management: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4619326/
https://www.ncbi.nlm.nih.gov/pubmed/26500000
http://dx.doi.org/10.1186/s12902-015-0058-6
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