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During the hospital stay, he was found to have postural hypotension, hypoglycaemia, hyponatraemia, hyperkalaemia, pancytopenia, hypothyroidism, hyperglobulinaemia and hypoalbuminaemia with reversal of serum albumin\/globulin ratio. The morning plasma cortisol was lower than normal and could not be appropriately stimulated after the Synacthen test. The bone marrow histopathology was suggestive of visceral leishmaniasis. He was diagnosed as a case of visceral leishmaniasis and HIV coinfection with primary adrenal insufficiency (Addison\u2019s disease) and primary hypothyroidism, as a rare and unusual presentation.<\/jats:p>","DOI":"10.1136\/bcr-2020-238488","type":"journal-article","created":{"date-parts":[[2021,3,5]],"date-time":"2021-03-05T14:43:30Z","timestamp":1614955410000},"page":"e238488","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Addison\u2019s disease with primary hypothyroidism in a case of visceral leishmaniasis and HIV coinfection"],"prefix":"10.1136","volume":"14","author":[{"given":"Monu","family":"Rani","sequence":"first","affiliation":[{"name":"Department of Endocrinology and Medicine, Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rakesh","family":"Garg","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Medicine, Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Venkatesh Darshan","family":"Agraharabachalli Nanjunde","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Medicine, Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rajesh","family":"Rajput","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Medicine, Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,3,5]]},"reference":[{"key":"2025082709314303000_14.3.e238488.1","unstructured":"[Internet]. 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