A Case of Diagnostic Delay: Autoimmune Adrenalitis Mimicking Functional Gastrointestinal Disorder.
Nikhil Kumar Gupta, Ambuj Yadav, Manohar Jha
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Case in brief
A 23-year-old man with previously treated tuberculous meningitis presented with recurrent vomiting, generalized weakness, and altered behavior. He was hypotensive and drowsy, with hyponatremia and hyperkalemia. Low serum cortisol and elevated ACTH indicated primary adrenal insufficiency; imaging excluded tuberculous adrenal involvement, supporting autoimmune adrenalitis as the cause of an Addisonian crisis. He improved with intravenous hydrocortisone, fluids, and supportive care, then transitioned to oral steroid replacement and was discharged on maintenance therapy.
What made this case unusual
The gastrointestinal and behavioral symptoms could mimic functional gastrointestinal or psychiatric illness, while the history of tuberculous meningitis made tuberculous adrenal involvement a competing explanation; imaging excluded that involvement.
Diagnostic / clinical pearl
In a young patient with unexplained vomiting, weakness, or behavioral change—particularly with prior central nervous system tuberculosis—consider adrenal insufficiency and assess cortisol and ACTH, especially when hypotension and electrolyte abnormalities are present.