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A high index of suspicion should be kept for diagnosing primary adrenal insufficiency in a child presenting with recurrent episodes of vomiting and diarrhoea with laboratory evidence of metabolic acidosis and hypoglycaemia. Primary adrenal insufficiency, in a male child specifically, should raise alarm for X-linked adrenoleukodystrophy (X-ALD). Very-long-chain fatty acids and confirmatory genetic testing for an <jats:italic>ABCD1<\/jats:italic> gene mutation can help confirm the diagnosis. Addison\u2019s disease often presents prior to the onset of the cerebral form of X-ALD. Early diagnosis of X-ALD allows for MRI screening for the development of cerebral disease in its early stages when treatment with stem cell transplant can halt the disease and be lifesaving.<\/jats:p>","DOI":"10.1136\/bcr-2022-249905","type":"journal-article","created":{"date-parts":[[2022,8,10]],"date-time":"2022-08-10T11:15:11Z","timestamp":1660130111000},"page":"e249905","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Recurrent episodes of vomiting and diarrhoea in a male child: a rare presentation of X-linked adrenoleukodystrophy"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1205-4391","authenticated-orcid":false,"given":"Pranav","family":"Gupta","sequence":"first","affiliation":[{"name":"Pediatric Endocrinology, Emory University School of Medicine, Atlanta, Georgia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephanie 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