{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T16:44:54Z","timestamp":1770741894190,"version":"3.49.0"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,3,25]],"date-time":"2021-03-25T00:00:00Z","timestamp":1616630400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2021,3,25]],"date-time":"2021-03-25T00:00:00Z","timestamp":1616630400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Med Case Reports"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Primary adrenal insufficiency (Addison's disease) is a rare medical condition usually associated with hyperkalemia or normokalemia. We report a rare case of Addison's disease, coexisting with hypokalemia, requiring treatment.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>In this case, a 42-year-old man was admitted to the intensive care unit with a history of loss of consciousness and severe hypoglycemia. His blood tests showed metabolic acidosis, low concentrations of cortisol 6\u00a0nmol\/L (normal 68\u2013327\u00a0nmol\/L), and high plasma adrenocorticotropic hormone 253\u00a0pmol\/L (normal 1.6\u201313.9\u00a0pmol\/L), and he was diagnosed with primary adrenal insufficiency. Surprisingly, his serum potassium was low, 2.3\u00a0mmol\/L (normal 3.5\u20135.1\u00a0mmol\/L), requiring replacement over the course of his admission. Computed tomography scan of the adrenal glands showed features suggestive of unilateral adrenal tuberculosis. Investigations confirmed renal tubulopathy. The patient responded favorably to cortisol replacement, but never required fludrocortisone.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Coexistence of hypokalemia with Addison\u2019s disease is unusual. We recommend investigation of the cause of hypokalemia in its own right, if it occurs with primary adrenal insufficiency.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13256-021-02724-6","type":"journal-article","created":{"date-parts":[[2021,3,25]],"date-time":"2021-03-25T00:05:34Z","timestamp":1616630734000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Addison\u2019s disease associated with hypokalemia: a\u00a0case report"],"prefix":"10.1186","volume":"15","author":[{"given":"M.","family":"Abdalla","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J. A.","family":"Dave","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"I. L.","family":"Ross","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,3,25]]},"reference":[{"issue":"3","key":"2724_CR1","doi-asserted-by":"publisher","first-page":"597","DOI":"10.1530\/EJE-09-0884","volume":"162","author":"S Hahner","year":"2010","unstructured":"Hahner S, Loeffler M, Bleicken B, Drechsler C, Milovanovic D, Fassnacht M, et\u00a0al. Epidemiology of adrenal crisis in chronic adrenal insufficiency: the need for new prevention strategies. Eur J Endocrinol. 2010;162(3):597\u2013602.","journal-title":"Eur J Endocrinol."},{"issue":"685","key":"2724_CR2","doi-asserted-by":"publisher","first-page":"690","DOI":"10.1136\/pgmj.58.685.690","volume":"58","author":"AH Barnett","year":"1982","unstructured":"Barnett AH, Espiner EA, Donald RA. Patients presenting with Addison\u2019s disease need not be pigmented. Postgrad Med J. 1982;58(685):690\u20132.","journal-title":"Postgrad Med J."},{"issue":"1","key":"2724_CR3","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1006\/jaut.1995.0009","volume":"8","author":"PMJ Zelissen","year":"1995","unstructured":"Zelissen PMJ, Bast EJEG, Croughs RJM. Associated autoimmunity in Addison\u2019s disease. J Autoimmun. 1995;8(1):121\u201330. https:\/\/doi.org\/10.1006\/jaut.1995.0009.","journal-title":"J Autoimmun."},{"issue":"3","key":"2724_CR4","doi-asserted-by":"publisher","first-page":"216","DOI":"10.1016\/S2213-8587(14)70142-1","volume":"3","author":"I Bancos","year":"2015","unstructured":"Bancos I, Hahner S, Tomlinson J, Arlt W. Diagnosis and management of adrenal insufficiency. Lancet Diabetes Endocrinol. 2015;3(3):216\u201326.","journal-title":"Lancet Diabetes Endocrinol."},{"issue":"2","key":"2724_CR5","doi-asserted-by":"publisher","first-page":"364","DOI":"10.1210\/jc.2015-1710","volume":"101","author":"SR Bornstein","year":"2016","unstructured":"Bornstein SR, Allolio B, Arlt W, Barthel A, Don-Wauchope A, Hammer GD, et\u00a0al. Diagnosis and treatment of primary adrenal insufficiency: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2016;101(2):364\u201389.","journal-title":"J Clin Endocrinol Metab."},{"issue":"6","key":"2724_CR6","doi-asserted-by":"publisher","first-page":"587","DOI":"10.1038\/ki.1982.216","volume":"22","author":"S Ishikawa","year":"1982","unstructured":"Ishikawa S, Schrier RW. Effect of arginine vasopressin antagonist on renal water excretion in glucocorticoid and mineralocorticoid deficient rats. Kidney Int. 1982;22(6):587\u201393. https:\/\/doi.org\/10.1038\/ki.1982.216.","journal-title":"Kidney Int."},{"issue":"1","key":"2724_CR7","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1038\/ki.1980.14","volume":"17","author":"RA DeFronzo","year":"1980","unstructured":"DeFronzo RA. Hyperkalemia and hyporeninemic hypoaldosteronism. Kidney Int. 1980;17(1):118\u201334. https:\/\/doi.org\/10.1038\/ki.1980.14.","journal-title":"Kidney Int."},{"issue":"2","key":"2724_CR8","doi-asserted-by":"publisher","first-page":"190","DOI":"10.1111\/joim.12699","volume":"283","author":"B S\u00e6vik","year":"2018","unstructured":"S\u00e6vik B, \u00c5kerman AK, Gr\u00f8nning K, Nermoen I, Valland SF, Finnes TE, et\u00a0al. Clues for early detection of autoimmune Addison\u2019s disease\u2014myths and realities. J Intern Med. 2018;283(2):190\u20139.","journal-title":"J Intern Med."},{"key":"2724_CR9","doi-asserted-by":"crossref","unstructured":"Palmer LG, Frindt G. Regulation of apical K channels in rat cortical collecting tubule during changes in dietary K intake. Am J Physiol Ren Physiol. 1999;277(5 46-5):805\u201312.","DOI":"10.1152\/ajprenal.1999.277.5.F805"},{"issue":"1","key":"2724_CR10","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1371\/journal.pone.0053526","volume":"8","author":"IL Ross","year":"2013","unstructured":"Ross IL, Levitt NS. Addison\u2019s disease symptoms\u2014a cross sectional study in urban South Africa. PLoS ONE. 2013;8(1):9.","journal-title":"PLoS ONE"},{"issue":"3","key":"2724_CR11","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1007\/s00467-015-3143-1","volume":"31","author":"HW Seyberth","year":"2016","unstructured":"Seyberth HW. Pathophysiology and clinical presentations of salt-losing tubulopathies. Pediatr Nephrol. 2016;31(3):407\u201318.","journal-title":"Pediatr Nephrol."},{"issue":"1","key":"2724_CR12","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1016\/j.kint.2019.09.018","volume":"97","author":"CM Clase","year":"2020","unstructured":"Clase CM, Carrero JJ, Ellison DH, Grams ME, Hemmelgarn BR, Jardine MJ, et\u00a0al. Potassium homeostasis and management of dyskalemia in kidney diseases: conclusions from a kidney disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int. 2020;97(1):42\u201361.","journal-title":"Kidney Int."},{"key":"2724_CR13","doi-asserted-by":"publisher","unstructured":"Article SEER. Urine tests for chronic hypokalemia\u202f: when in doubt , check urine-sodium-to-chloride ratio. Am J Med. 130(7):761\u20132. https:\/\/doi.org\/10.1016\/j.amjmed.2017.02.040","DOI":"10.1016\/j.amjmed.2017.02.040"},{"issue":"6","key":"2724_CR14","doi-asserted-by":"publisher","first-page":"1589","DOI":"10.1097\/01.ASN.0000125677.06809.37","volume":"15","author":"JM Wiederseiner","year":"2004","unstructured":"Wiederseiner JM, Muser J, Lutz T, Hulter HN, Krapf R. Acute metabolic acidosis: characterization and diagnosis of the disorder and the plasma potassium response. J Am Soc Nephrol. 2004;15(6):1589\u201396.","journal-title":"J Am Soc Nephrol."},{"issue":"6","key":"2724_CR15","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1136\/emj.2004.017590","volume":"23","author":"LC McGuire","year":"2006","unstructured":"McGuire LC, Cruickshank AM, Munro PT. Alcoholic ketoacidosis. Emerg Med J. 2006;23(6):417\u201320.","journal-title":"Emerg Med J."},{"key":"2724_CR16","doi-asserted-by":"publisher","first-page":"14481119","DOI":"10.2215\/CJN.14481119","volume":"4","author":"ML Downie","year":"2020","unstructured":"Downie ML, Lopez Garcia SC, Kleta R, Bockenhauer D. Inherited tubulopathies of the kidney. Clin J Am Soc Nephrol. 2020;4:14481119.","journal-title":"Clin J Am Soc Nephrol."},{"issue":"6","key":"2724_CR17","doi-asserted-by":"publisher","first-page":"1184","DOI":"10.1053\/j.ajkd.2010.07.010","volume":"56","author":"BF Palmer","year":"2010","unstructured":"Palmer BF. A physiologic-based approach to the evaluation of a patient with hypokalemia. Am J Kidney Dis. 2010;56(6):1184\u201390. https:\/\/doi.org\/10.1053\/j.ajkd.2010.07.010.","journal-title":"Am J Kidney Dis."},{"issue":"3","key":"2724_CR18","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1111\/j.1365-2265.2010.03807.x","volume":"73","author":"I Ross","year":"2010","unstructured":"Ross I, Boulle A, Soule S, Levitt N, Pirie F, Karlsson A, et\u00a0al. Autoimmunity predominates in a large South African cohort with Addison\u2019s disease of mainly European descent despite long-standing disease and is associated with HLA DQB*0201. Clin Endocrinol (Oxf). 2010;73(3):291\u20138.","journal-title":"Clin Endocrinol (Oxf)."},{"issue":"1","key":"2724_CR19","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1471-2369-14-13","volume":"14","author":"HK Min","year":"2013","unstructured":"Min HK, Kim EO, Lee SJ, Chang YK, Suh KS, Yang CW, et\u00a0al. Rifampin-associated tubulointersititial nephritis and Fanconi syndrome presenting as hypokalemic paralysis. BMC Nephrol. 2013;14(1):1.","journal-title":"BMC Nephrol."},{"issue":"5","key":"2724_CR20","doi-asserted-by":"publisher","first-page":"633","DOI":"10.1046\/j.1365-2265.2001.01266.x","volume":"54","author":"KY Lam","year":"2001","unstructured":"Lam KY, Lo CY. A critical examination of adrenal tuberculosis and a 28-year autopsy experience of active tuberculosis. Clin Endocrinol (Oxf). 2001;54(5):633\u20139.","journal-title":"Clin Endocrinol (Oxf)."},{"issue":"3","key":"2724_CR21","doi-asserted-by":"publisher","first-page":"461","DOI":"10.1016\/0002-9343(85)90339-0","volume":"78","author":"JA Vita","year":"1985","unstructured":"Vita JA, Silverberg SJ, Goland RS, Austin JHM, Knowlton AI. Clinical clues to the cause of Addison\u2019s disease. Am J Med. 1985;78(3):461\u20136.","journal-title":"Am J Med."},{"issue":"9","key":"2724_CR22","doi-asserted-by":"publisher","first-page":"2031","DOI":"10.1007\/s00330-005-0096-y","volume":"16","author":"ZG Yang","year":"2006","unstructured":"Yang ZG, Guo YK, Li Y, Min PQ, Yu JQ, Ma ES. Differentiation between tuberculosis and primary tumors in the adrenal gland: evaluation with contrast-enhanced CT. Eur Radiol. 2006;16(9):2031\u20136.","journal-title":"Eur Radiol."},{"key":"2724_CR23","doi-asserted-by":"crossref","unstructured":"Guo YK, Yang ZG, Li Y, Ma E Sen, Deng YP, Min PQ, et\u00a0al. Addison\u2019s disease due to adrenal tuberculosis: contrast-enhanced CT features and clinical duration correlation. Eur J Radiol. 2007;62(1):126\u201331.","DOI":"10.1016\/j.ejrad.2006.11.025"},{"issue":"9","key":"2724_CR24","first-page":"3163","volume":"83","author":"S Laureti","year":"1998","unstructured":"Laureti S, Aubourg P, Calcinaro F, Rocchiccioli F, Casucci G, Angeletti G, et\u00a0al. Etiological diagnosis of primary adrenal insufficiency using an original flowchart of immune and biochemical markers. J Clin Endocrinol Metab. 1998;83(9):3163\u20138.","journal-title":"J Clin Endocrinol Metab."},{"issue":"6","key":"2724_CR25","doi-asserted-by":"publisher","first-page":"2536","DOI":"10.1210\/jc.2009-2354","volume":"95","author":"S Bhasin","year":"2010","unstructured":"Bhasin S, Cunningham GR, Hayes FJ, Matsumoto AM, Snyder PJ, Swerdloff RS, et\u00a0al. Testosterone therapy in men with androgen deficiency syndromes: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2010;95(6):2536\u201359.","journal-title":"J Clin Endocrinol Metab."},{"key":"2724_CR26","unstructured":"Hayes F, Dwyer A, Pitteloud N. Hypogonadotropic Hypogonadism (HH) and Gonadotropin Therapy. In: Feingold KR, Anawalt B, Boyce A, et\u00a0al., editors. Endotext. South Dartmouth: MDTextcom Inc; 2000"},{"issue":"10","key":"2724_CR27","doi-asserted-by":"publisher","first-page":"691","DOI":"10.1055\/s-0034-1374589","volume":"46","author":"IL Ross","year":"2014","unstructured":"Ross IL, Levitt NS, Blom DJ, Haarburger D. Male and female hypogonadism are highly prevalent in South Africans with Addison\u2019s disease. Horm Metab Res. 2014;46(10):691\u20136.","journal-title":"Horm Metab Res."},{"issue":"5","key":"2724_CR28","first-page":"1871","volume":"81","author":"S Chen","year":"1996","unstructured":"Chen S, Sawicka J, Betterle C, Powell M, Prentice L, Volpato M, et\u00a0al. Autoantibodies to steroidogenic enzymes in autoimmune polyglandular syndrome, Addison\u2019s disease, and premature ovarian failure. J Clin Endocrinol Metab. 1996;81(5):1871\u20136.","journal-title":"J Clin Endocrinol Metab."},{"issue":"2","key":"2724_CR29","doi-asserted-by":"publisher","first-page":"453","DOI":"10.1210\/jcem-70-2-453","volume":"70","author":"CA Spencer","year":"1990","unstructured":"Spencer CA, Lopresti JS, Patel A, Guttler RB, Eigen A, Shen D, et\u00a0al. Applications of a new chemiluminometric thyrotropin assay to subnormal measurement. J Clin Endocrinol Metab. 1990;70(2):453\u201360.","journal-title":"J Clin Endocrinol Metab."},{"key":"2724_CR30","first-page":"1097014","volume":"2007","author":"CA Rodrigues","year":"2008","unstructured":"Rodrigues CA, Lennard-Jones J, Thompson DG, Farthing MJG. Serum TSH and thyroid antibody studies in Addison\u2019s diseases. Serum. 2008;2007:1097014\u20131097014.","journal-title":"Serum."},{"issue":"4","key":"2724_CR31","first-page":"1388","volume":"85","author":"MH Samuels","year":"2000","unstructured":"Samuels MH. Effects of variations in physiological cortisol levels on thyrotropin secretion in subjects with adrenal insufficiency: a clinical research center study. J Clin Endocrinol Metab. 2000;85(4):1388\u201393.","journal-title":"J Clin Endocrinol Metab."},{"issue":"2","key":"2724_CR32","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1016\/0002-9343(85)90022-1","volume":"79","author":"TD Stryker","year":"1985","unstructured":"Stryker TD, Molitch ME, Stryker TD, Molitch ME. Reversible hyperthyrotropinemia, hyperthyroxinemia, and hyperprolactinemia due to adrenal insufficiency. Am J Med. 1985;79(2):271\u20136. https:\/\/doi.org\/10.1016\/0002-9343(85)90022-1.","journal-title":"Am J Med."}],"container-title":["Journal of Medical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s13256-021-02724-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s13256-021-02724-6\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s13256-021-02724-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,3,25]],"date-time":"2021-03-25T00:12:48Z","timestamp":1616631168000},"score":1,"resource":{"primary":{"URL":"https:\/\/jmedicalcasereports.biomedcentral.com\/articles\/10.1186\/s13256-021-02724-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,25]]},"references-count":32,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["2724"],"URL":"https:\/\/doi.org\/10.1186\/s13256-021-02724-6","relation":{},"ISSN":["1752-1947"],"issn-type":[{"value":"1752-1947","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,25]]},"assertion":[{"value":"28 July 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 February 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 March 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The faculty of Health Sciences, Human Research and Ethics Committee University of Cape Town waives the need for ethics approval for case studies, but individual patient consent is required for publication. Patient consent was obtained.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no conflicts of interest.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"131"}}