{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T07:14:22Z","timestamp":1783667662395,"version":"3.55.0"},"reference-count":48,"publisher":"BMJ","issue":"12","funder":[{"name":"NIH","award":["DK121146"],"award-info":[{"award-number":["DK121146"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2022,11,28]]},"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:p>A man in his 20s with a history of acute disseminated encephalomyelitis (ADEM) was brought into the emergency department (ED) after his family found him at home collapsed on the floor unresponsive with a blood glucose of 28\u2009mg\/dL at the field. In the ED, the patient was tachycardic, tachypnoeic and hypotensive, requiring pressors and intubation at 9\u2009hours and 12 hours after arrival, respectively. Laboratory results revealed a positive COVID-19 test, serum sodium of 125\u2009mmol\/L and persistent hypoglycaemia. The patient was given a high dose of dexamethasone for COVID-19 treatment 1\u2009hour before pressors were started. He was then continued on a stress dose of intravenous hydrocortisone with rapid clinical improvement leading to his extubation, and discontinuation of vasopressors and glucose on day 2 of admission. The patient received his last dose of intravenous hydrocortisone on day 4 in the early afternoon with the plan to order adrenal testing the following morning prior to discharge. On day 5, the aldosterone &lt;3.0\u2009ng\/dL, adrenocorticotropic hormone (ACTH) level &gt;1250\u2009pg\/mL, and ACTH stimulation test showed cortisol levels of 3 and 3 \u00b5g\/dL at 30 and 60\u2009min, respectively. The anti-21-hydroxylase antibody was positive. The patient was discharged on hydrocortisone and fludrocortisone. The patient\u2019s symptoms, elevated ACTH, low cortisol and presence of 21-hydroxylase antibodies are consistent with autoimmune Addison\u2019s disease. This is the first case reporting autoimmune Addison\u2019s disease in a patient with COVID-19 with a history of ADEM. The case highlights the importance of considering adrenal insufficiency as a diagnostic differential in haemodynamically unstable patients with COVID-19.<\/jats:p>","DOI":"10.1136\/bcr-2022-250749","type":"journal-article","created":{"date-parts":[[2022,12,5]],"date-time":"2022-12-05T10:20:22Z","timestamp":1670235622000},"page":"e250749","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Newly diagnosed autoimmune Addison\u2019s disease in a patient with COVID-19 with autoimmune disseminated encephalomyelitis"],"prefix":"10.1136","volume":"15","author":[{"given":"Lauren","family":"Beshay","sequence":"first","affiliation":[{"name":"Endocrinology, University of California Irvine, Irvine, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Wei","sequence":"additional","affiliation":[{"name":"Endocrinology, University of California Irvine, Orange, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qin","family":"Yang","sequence":"additional","affiliation":[{"name":"Endocrinology, University of California Irvine, Irvine, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,12,5]]},"reference":[{"key":"2025082712453197000_15.12.e250749.1","unstructured":"Chippa V , Aleem A , Anjum F . 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