SIADH versus adrenal insufficiency: A life-threatening misdiagnosis

Stefano Pintaldi, Angela Lora, Katy Vecchiato, Andrea Taddio, Egidio Barbi

Research output: Contribution to journalArticle

Abstract

Background: Primary adrenal insufficiency (PAI) in children is an uncommon but severe condition which can be either inherited or acquired. It consists in clinical manifestation of defective production or ineffective action of endogenous glucocorticoids; deficiency in mineralocorticoids and adrenal androgens may coexist. Diagnosis of PAI in children and young people can be challenging; while adrenal crisis (acute decompensation) is a life-threatening condition, with patient presenting with characteristic features of hypoglycemia, hypotension, collapse and coma, chronic adrenal insufficiency may present with vague and non-specific symptoms, making the diagnosis more difficult. 1 Gastroenteritis and Syndrome of Inappropriate Secretion of Antidiuretic hormone (SIADH) are the most frequent reported misdiagnosis in patients with adrenal insufficiency (AI). While intravenous fluid replacement in the suspect of a gastroenteritis would be beneficial, a SIADH misdiagnosis can be harmful since the treatment of this condition is based primarily on fluid restriction. Case presentation: We report the case of a child admitted to the emergency department whose condition was ultimately diagnosed as autoimmune adrenal insufficiency after few hours of inappropriate fluid restriction following a SIADH misdiagnosis. Conclusions: AI is a rare condition in children and the diagnosis can be challenging. A missed diagnosis of AI or an inadequate treatment may cause severe complications, especially if a SIADH is erroneously diagnosed. Emergency physicians and pediatricians should be familiar with this diagnosis to enhance early recognition of this potentially life-threatening condition.

Original languageEnglish
Article number23
JournalItalian Journal of Pediatrics
Volume45
Issue number1
DOIs
Publication statusPublished - Feb 6 2019

Keywords

  • Addison disease
  • Adrenal insufficiency
  • Gastroenteritis
  • Hyponatremia
  • Primary adrenal insufficiency
  • Syndrome of inappropriate antidiuretic hormone secretion

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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