A Challenging Case of Adrenal Insufficiency Presenting with Hypertensive Crisis

Abstract

Adrenal insufficiency is the deficient production or action of glucocorticoids, with or without deficiency in mineralocorticoids or adrenal androgens. It usually presents with anorexia, abdominal pain, weakness, weight loss, fatigue, and hypotension. We report a case of 67 year old male, who is known to have hypertension, presented to emergency room with severe headache and was found to have high blood pressure 241/135mmHg and hypoosmolar hyponatremia. He was started on intravenous nicardipine and his blood pressure dropped suddenly, became orthostatic, and required fluid resuscitation but his headache resolved. On next day, the cosyntropin test was suggestive of primary adrenal insufficiency. The patient was started on oral hydrocortisone with improvement in his blood pressure and hyponatremia.