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Addison's Disease Presenting as Acute Renal Failure and Hyperkalemic Paralysis: A Rare Presentation

Hyperkalemic paralysis in the setting of acute renal failure can lead to a missed or delayed diagnosis of adrenal insufficiency as the raised potassium can be attributed to the renal failure. Acute kidney injury as the presenting manifestation in an adrenal crisis due to Addison's disease has b...

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Autores principales: Jana, Kundan, Janga, Kalyana, Greenberg, Sheldon, Gulati, Amit
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8716199/
https://www.ncbi.nlm.nih.gov/pubmed/34976418
http://dx.doi.org/10.1155/2021/3103011
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author Jana, Kundan
Janga, Kalyana
Greenberg, Sheldon
Gulati, Amit
author_facet Jana, Kundan
Janga, Kalyana
Greenberg, Sheldon
Gulati, Amit
author_sort Jana, Kundan
collection PubMed
description Hyperkalemic paralysis in the setting of acute renal failure can lead to a missed or delayed diagnosis of adrenal insufficiency as the raised potassium can be attributed to the renal failure. Acute kidney injury as the presenting manifestation in an adrenal crisis due to Addison's disease has been rarely reported in the literature. Here, we present the case of a young 37-year-old male who came with hyperkalemic paralysis and acute renal failure needing emergent hemodialysis. He had no past medical history and no medication history. His hyponatremia, hypotension, and hyperkalemia pointed to a picture of adrenal insufficiency confirmed by undetectable serum cortisol, elevated ACTH, renin, and low aldosterone levels and imaging. Replacement steroid therapy was given, and the patient made a steady recovery. He was advised on the importance of compliance to treatment at discharge to prevent another crisis event. Acute renal failure with hyperkalemia as a presenting manifestation of Addison's disease can be very misleading. It is especially important to be vigilant of adrenal insufficiency in such patients as the hyperkalemia is resistant to standard therapy of insulin dextrose and can precipitate fatal arrhythmia if treatment is delayed.
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spelling pubmed-87161992021-12-30 Addison's Disease Presenting as Acute Renal Failure and Hyperkalemic Paralysis: A Rare Presentation Jana, Kundan Janga, Kalyana Greenberg, Sheldon Gulati, Amit Case Rep Endocrinol Case Report Hyperkalemic paralysis in the setting of acute renal failure can lead to a missed or delayed diagnosis of adrenal insufficiency as the raised potassium can be attributed to the renal failure. Acute kidney injury as the presenting manifestation in an adrenal crisis due to Addison's disease has been rarely reported in the literature. Here, we present the case of a young 37-year-old male who came with hyperkalemic paralysis and acute renal failure needing emergent hemodialysis. He had no past medical history and no medication history. His hyponatremia, hypotension, and hyperkalemia pointed to a picture of adrenal insufficiency confirmed by undetectable serum cortisol, elevated ACTH, renin, and low aldosterone levels and imaging. Replacement steroid therapy was given, and the patient made a steady recovery. He was advised on the importance of compliance to treatment at discharge to prevent another crisis event. Acute renal failure with hyperkalemia as a presenting manifestation of Addison's disease can be very misleading. It is especially important to be vigilant of adrenal insufficiency in such patients as the hyperkalemia is resistant to standard therapy of insulin dextrose and can precipitate fatal arrhythmia if treatment is delayed. Hindawi 2021-12-22 /pmc/articles/PMC8716199/ /pubmed/34976418 http://dx.doi.org/10.1155/2021/3103011 Text en Copyright © 2021 Kundan Jana et al. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Jana, Kundan
Janga, Kalyana
Greenberg, Sheldon
Gulati, Amit
Addison's Disease Presenting as Acute Renal Failure and Hyperkalemic Paralysis: A Rare Presentation
title Addison's Disease Presenting as Acute Renal Failure and Hyperkalemic Paralysis: A Rare Presentation
title_full Addison's Disease Presenting as Acute Renal Failure and Hyperkalemic Paralysis: A Rare Presentation
title_fullStr Addison's Disease Presenting as Acute Renal Failure and Hyperkalemic Paralysis: A Rare Presentation
title_full_unstemmed Addison's Disease Presenting as Acute Renal Failure and Hyperkalemic Paralysis: A Rare Presentation
title_short Addison's Disease Presenting as Acute Renal Failure and Hyperkalemic Paralysis: A Rare Presentation
title_sort addison's disease presenting as acute renal failure and hyperkalemic paralysis: a rare presentation
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8716199/
https://www.ncbi.nlm.nih.gov/pubmed/34976418
http://dx.doi.org/10.1155/2021/3103011
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