{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T15:57:11Z","timestamp":1790870231204,"version":"4.1.0"},"reference-count":11,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2015,5,14]]},"abstract":"<jats:p>We present a case of rapidly progressing Addison's disease in adrenal crisis with severe hyponatraemia and absence of hyperkalaemia in a 10-year-old girl. She presented with 2\u2005weeks of vomiting, fatigue and weight loss. Her serum electrolytes obtained 1\u2005week prior to presentation were normal, except for mild hyponatraemia at 131\u2005mmol\/L, which dropped to 112\u2005mmol\/L on admission. She had normal serum potassium, low-serum osmolality, with elevated urine sodium and osmolality, indistinguishable from syndrome of inappropriate antidiuretic hormone (SIADH). Subsequently, Addison's disease was diagnosed on the basis of gingival hyperpigmentation and undetectable cortisol on adrenocorticotropic hormone stimulation test. She rapidly responded to stress dose hydrocortisone, followed by hydrocortisone and fludrocortisone replacement therapy. The absence of hyperkalaemia in the presence of severe hyponatraemia cannot rule out Addison's disease in children. The mechanism of hypo-osmolar hyponatraemia in primary adrenal insufficiency and clinical clues to differentiate it from SIADH are discussed.<\/jats:p>","DOI":"10.1136\/bcr-2015-209903","type":"journal-article","created":{"date-parts":[[2015,5,28]],"date-time":"2015-05-28T13:44:58Z","timestamp":1432820698000},"page":"bcr2015209903","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Severe hyponatraemia with absence of hyperkalaemia in rapidly progressive Addison's disease"],"prefix":"10.1136","volume":"2015","author":[{"given":"Michael D","family":"Thompson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eileen","family":"Kalmar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sasigarn A","family":"Bowden","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2015,5,28]]},"reference":[{"key":"2025042706251279000_2015.may27_1.bcr2015209903.1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2004-0016"},{"key":"2025042706251279000_2015.may27_1.bcr2015209903.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9610(97)00136-0"},{"key":"2025042706251279000_2015.may27_1.bcr2015209903.3","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.1016\/S0140-6736(57)91687-2","article-title":"Auto-antibodies in Addison's disease","volume":"272","author":"Anderson","year":"1957","journal-title":"Lancet"},{"key":"2025042706251279000_2015.may27_1.bcr2015209903.4","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-33-4-787"},{"key":"2025042706251279000_2015.may27_1.bcr2015209903.5","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1754.2004.00482.x"},{"key":"2025042706251279000_2015.may27_1.bcr2015209903.6","doi-asserted-by":"crossref","first-page":"pii: bcr0720114561","DOI":"10.1136\/bcr.07.2011.4561","article-title":"Extreme hyponatraemia with intact neurological outcome in a young child with Addison's disease","volume":"2011","author":"Smith","year":"2011","journal-title":"BMJ Case Rep"},{"key":"2025042706251279000_2015.may27_1.bcr2015209903.7","doi-asserted-by":"publisher","DOI":"10.1210\/jc.77.6.1584"},{"key":"2025042706251279000_2015.may27_1.bcr2015209903.8","first-page":"97","article-title":"Addisonian pigmentation of the oral mucosa","volume":"76","author":"Shah","year":"2005","journal-title":"Cutis"},{"key":"2025042706251279000_2015.may27_1.bcr2015209903.9","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.2.5362.887"},{"key":"2025042706251279000_2015.may27_1.bcr2015209903.10","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2011-0015"},{"key":"2025042706251279000_2015.may27_1.bcr2015209903.11","doi-asserted-by":"crossref","unstructured":"White PC , Bachega TA . eds. 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