Primary Adrenal Failure in the Emergency Department

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BackgroundPrimary adrenal failure is considered to be an extremely rare disease presenting in the ED, with an incidence reported to be as low as 50 cases per 1,000,000 persons (Klauer, 2017).I would like to present a case of a young man who presented to the ED, with what I suspected to be this rare entity.Case reportA 26 year old otherwise healthy male presented to our ED with complaints of weakness, nausea, vomiting, and hiccups of 1.5-day duration. He also complained of lightheadedness, describing it as if he was going to pass out. Other than slight tachycardia (100) and darkened skin, his physical exam, ROS, PMH, Family and Social History, were all unremarkable.His sodium returned at 111, and he was later noted to become more confused in the ED prompting the emergent use of Hypertonic Saline.Why should an emergency physician be aware of this?Albeit a rare disease entity, EPs need to keep this life threatening disease process in the back of their minds when presented with a patient with vague symptoms such as weakness or fatigue, electrolyte abnormalities and darkening of their skin.

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