{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T02:47:42Z","timestamp":1767840462201,"version":"3.49.0"},"reference-count":7,"publisher":"Walter de Gruyter GmbH","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,4,26]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec id=\"j_jpem-2021-0193_abs_001\">\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To describe an atypical presentation of primary adrenal insufficiency in conjunction with new onset type 1 diabetes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_jpem-2021-0193_abs_002\">\n                  <jats:title>Case presentation<\/jats:title>\n                  <jats:p>Here, we describe a case of new-onset type 1 diabetes (T1D) presenting simultaneously with an unusual presentation of primary adrenal insufficiency in a previously healthy 16-year-old. He was admitted for a typical presentation of diabetic ketoacidosis, but with extreme hyponatremia. An extensive workup revealed a low aldosterone level, appropriate cortisol level, and positive 21-hydroxylase antibodies. While the phenomenon of multiple autoimmune conditions developing in the same patient is well-described, this particular case has several atypical aspects. Our patient\u2019s case highlights the danger of relying on random serum cortisol in the setting of acute illness to rule out adrenal insufficiency.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_jpem-2021-0193_abs_003\">\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Adrenal insufficiency can present as isolated hypoaldosteronism without hypocortisolemia and can manifest as severe hyponatremia in the context of diabetic ketoacidosis. Workup for an unusual presentation of T1D should include a 21-hydroxylase antibody, as well as thyroid and celiac disease studies.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1515\/jpem-2021-0193","type":"journal-article","created":{"date-parts":[[2021,11,25]],"date-time":"2021-11-25T07:19:41Z","timestamp":1637824781000},"page":"531-534","source":"Crossref","is-referenced-by-count":4,"title":["An unusual presentation of primary adrenal insufficiency with new onset type 1 diabetes: case report and review of the literature"],"prefix":"10.1515","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6788-4523","authenticated-orcid":false,"given":"Shelby","family":"Graf","sequence":"first","affiliation":[{"name":"PGY-3, University of Minnesota Pediatrics , 2450 Riverside Ave., Room M136, 1st Floor, East Building , Minneapolis , MN 55454 , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachel Stork","family":"Poeppelman","sequence":"additional","affiliation":[{"name":"Pediatric Critical Care , University of Minnesota Masonic Children\u2019s Hospital , Minneapolis , MN , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"McVean","sequence":"additional","affiliation":[{"name":"Pediatric Endocrinology and Diabetes , University of Minnesota Masonic Children\u2019s Hospital , Minneapolis , MN , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arpana","family":"Rayannavar","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Endocrinology and Diabetes , University of Minnesota Masonic Children\u2019s Hospital , Minneapolis , MN , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muna","family":"Sunni","sequence":"additional","affiliation":[{"name":"Pediatric Endocrinology , University of Minnesota Masonic Children\u2019s Hospital , Minneapolis , MN , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"374","published-online":{"date-parts":[[2021,11,24]]},"reference":[{"key":"2023033123535385489_j_jpem-2021-0193_ref_001","doi-asserted-by":"crossref","unstructured":"Erichsen, MM, L\u00f8v\u00e5s, K, Skinningsrud, B, Wolff, AB, Undlien, DE, Svartberg, J, et al.. Clinical, immunological, and genetic features of autoimmune primary adrenal insufficiency: observations from a Norwegian registry. J Clin Endocrinol Metab 2009;94:4882\u201390. https:\/\/doi.org\/10.1210\/jc.2009-1368.","DOI":"10.1210\/jc.2009-1368"},{"key":"2023033123535385489_j_jpem-2021-0193_ref_002","doi-asserted-by":"crossref","unstructured":"Brewer, KW, Parziale, VS, Eisenbarth, GS. Screening patients with insulin-dependent diabetes mellitus for adrenal insufficiency. N\u00a0Engl J Med 1997;337:202. https:\/\/doi.org\/10.1056\/nejm199707173370314.","DOI":"10.1056\/NEJM199707173370314"},{"key":"2023033123535385489_j_jpem-2021-0193_ref_003","doi-asserted-by":"crossref","unstructured":"Baker, PR, Nanduri, P, Gottlieb, PA, Yu, L, Klingensmith, GJ, Eisenbarth, GS, et al.. Predicting the onset of Addison\u2019s disease: ACTH, renin, cortisol and 21\u2010hydroxylase autoantibodies. Clin Endocrinol 2012;76:617\u201324. https:\/\/doi.org\/10.1111\/j.1365-2265.2011.04276.x.","DOI":"10.1111\/j.1365-2265.2011.04276.x"},{"key":"2023033123535385489_j_jpem-2021-0193_ref_004","doi-asserted-by":"crossref","unstructured":"Betterle, C, Scalici, C, Presotto, F, Pedini, B, Moro, L, Rigon, F, et al.. The natural history of adrenal function in autoimmune patients with adrenal autoantibodies. J Endocrinol 1988;117:467\u201375. https:\/\/doi.org\/10.1677\/joe.0.1170467.","DOI":"10.1677\/joe.0.1170467"},{"key":"2023033123535385489_j_jpem-2021-0193_ref_005","doi-asserted-by":"crossref","unstructured":"American Diabetes Association. Standards of medical care in diabetes\u20142010. Diabetes Care 2010;33(1 Suppl):S11\u201361. https:\/\/doi.org\/10.2337\/dc10-S004.","DOI":"10.2337\/dc10-S011"},{"key":"2023033123535385489_j_jpem-2021-0193_ref_006","doi-asserted-by":"crossref","unstructured":"Dittmar, M, Kahaly, GJ. Polyglandular autoimmune syndromes: immunogenetics and long-term follow-up. J Clin Endocrinol Metab 2003;88:2983\u201392. https:\/\/doi.org\/10.1210\/jc.2002-021845.","DOI":"10.1210\/jc.2002-021845"},{"key":"2023033123535385489_j_jpem-2021-0193_ref_007","doi-asserted-by":"crossref","unstructured":"Eisenbarth, GS, Gottlieb, PA. Autoimmune polyendocrine syndromes. N Engl J Med 2004;350:2068\u201379. https:\/\/doi.org\/10.1056\/nejmra030158.","DOI":"10.1056\/NEJMra030158"}],"container-title":["Journal of Pediatric Endocrinology and Metabolism"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.degruyter.com\/document\/doi\/10.1515\/jpem-2021-0193\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.degruyter.com\/document\/doi\/10.1515\/jpem-2021-0193\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,1]],"date-time":"2023-04-01T13:14:03Z","timestamp":1680354843000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.degruyter.com\/document\/doi\/10.1515\/jpem-2021-0193\/html"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,24]]},"references-count":7,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2022,2,16]]},"published-print":{"date-parts":[[2022,4,26]]}},"alternative-id":["10.1515\/jpem-2021-0193"],"URL":"https:\/\/doi.org\/10.1515\/jpem-2021-0193","relation":{},"ISSN":["0334-018X","2191-0251"],"issn-type":[{"value":"0334-018X","type":"print"},{"value":"2191-0251","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,24]]}}}