{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T13:52:27Z","timestamp":1753883547163,"version":"3.41.2"},"reference-count":9,"publisher":"The Endocrine Society","issue":"4","license":[{"start":{"date-parts":[[2023,8,9]],"date-time":"2023-08-09T00:00:00Z","timestamp":1691539200000},"content-version":"vor","delay-in-days":39,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["NIH-NIDDKB-T32DK065522-16"],"award-info":[{"award-number":["NIH-NIDDKB-T32DK065522-16"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>We describe a 14-year-old male who was followed for several years for the diagnoses of avoidant restrictive food intake disorder and generalized anxiety disorder before being diagnosed with primary adrenal insufficiency (PAI) or Addison disease. The patient presented multiple times to different facilities with worsening symptoms of anorexia, nausea, vomiting, and anxiety in the months leading up to diagnosis of PAI. Dehydration and hypotension, occurring relatively late in the course of his illness, were attributed to poor intake and vomiting. Hyponatremia was attributed to his psychotropic medication, olanzapine, and to dehydration. During his third hospitalization, he was diagnosed with PAI; treatment with stress-dose glucocorticoid therapy resulted in rapid clinical improvement. This case serves as a reminder that adrenal insufficiency must be considered in the differential diagnosis of eating disorders because signs and symptoms of adrenal insufficiency can overlap and progress insidiously. Additionally, we recognize that the diagnostic process is intertwined with a patient's medical history and use this opportunity to discuss cognitive, specifically anchoring, bias in academic medicine.<\/jats:p>","DOI":"10.1210\/jcemcr\/luad095","type":"journal-article","created":{"date-parts":[[2023,8,9]],"date-time":"2023-08-09T11:44:56Z","timestamp":1691581496000},"source":"Crossref","is-referenced-by-count":0,"title":["Primary Adrenal Insufficiency Masked by an Eating Disorder Diagnosis in an Adolescent Male"],"prefix":"10.1210","volume":"1","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9146-3195","authenticated-orcid":false,"given":"Presley","family":"Nichols","sequence":"first","affiliation":[{"name":"Division of Endocrinology Diabetes and Metabolism, Department of Pediatrics, Columbia University Irving Medical Center and NewYork Presbyterian Morgan Stanley Children's Hospital , New York, NY 10032 , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5067-4842","authenticated-orcid":false,"given":"Virginia","family":"Rahming","sequence":"additional","affiliation":[{"name":"Division of Endocrinology Diabetes and Metabolism, Department of Pediatrics, Columbia University Irving Medical Center and NewYork Presbyterian Morgan Stanley Children's Hospital , New York, NY 10032 , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1428-6674","authenticated-orcid":false,"given":"Alyson","family":"Weiner","sequence":"additional","affiliation":[{"name":"Division of Endocrinology Diabetes and Metabolism, Department of Pediatrics, Columbia University Irving Medical Center and NewYork Presbyterian Morgan Stanley Children's Hospital , New York, NY 10032 , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1049-031X","authenticated-orcid":false,"given":"Aviva B","family":"Sopher","sequence":"additional","affiliation":[{"name":"Division of Endocrinology Diabetes and Metabolism, Department of Pediatrics, Columbia University Irving Medical Center and NewYork Presbyterian Morgan Stanley Children's Hospital , New York, NY 10032 , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"80","published-online":{"date-parts":[[2023,8,9]]},"reference":[{"volume-title":"On the Constitutional and Local Effects of Disease of the Supra-Renal Capsules","year":"1855","author":"Addison","key":"2023080911444852900_luad095-B1"},{"issue":"2","key":"2023080911444852900_luad095-B2","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1210\/jc.2015-1710","article-title":"Diagnosis and treatment of primary adrenal insufficiency: an Endocrine Society clinical practice guideline","volume":"101","author":"Bornstein","year":"2016","journal-title":"J Clin Endocrinol Metab"},{"issue":"3","key":"2023080911444852900_luad095-B3","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1210\/clinem\/dgaa881","article-title":"Primary adrenal insufficiency in childhood: data from a large nationwide cohort","volume":"106","author":"Capalbo","year":"2021","journal-title":"J Clin Endocrinol Metab"},{"issue":"2","key":"2023080911444852900_luad095-B4","doi-asserted-by":"crossref","first-page":"e484","DOI":"10.1542\/peds.2006-1612","article-title":"Adrenal insufficiency: still a cause of morbidity and death in childhood","volume":"119","author":"Shulman","year":"2007","journal-title":"Pediatrics"},{"key":"2023080911444852900_luad095-B5","doi-asserted-by":"crossref","first-page":"k277","DOI":"10.1136\/bmj.k277","article-title":"Consider Addison's disease in differential diagnosis of eating disorders in children and young people","volume":"360","author":"Wass","year":"2018","journal-title":"BMJ"},{"issue":"3","key":"2023080911444852900_luad095-B6","doi-asserted-by":"crossref","first-page":"225","DOI":"10.4997\/jrcpe.2018.306","article-title":"Cognitive bias in clinical medicine","volume":"48","author":"O'Sullivan","year":"2018","journal-title":"J R Coll Physicians of Edinb"},{"issue":"1","key":"2023080911444852900_luad095-B7","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1186\/s12911-016-0377-1","article-title":"Cognitive biases associated with medical decisions: a systematic review","volume":"16","author":"Saposnik","year":"2016","journal-title":"BMC Med Inform Decis Mak"},{"issue":"5","key":"2023080911444852900_luad095-B8","first-page":"e8212","article-title":"Olanzapine-induced hyponatremia presenting with seizure requiring intensive care unit 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