Acta Med. 2025, 68: 31-36
https://doi.org/10.14712/18059694.2025.16
Two Hurt More Than One: Severe Hyponatraemia and Rhabdomyolysis as Presenting Features of Addison’s Disease
Luca Foppiania
, Christian Cascioa, Paola Pesceb, Giancarlo Antonuccia
, Christian Cascioa, Paola Pesceb, Giancarlo Antonuccia
aInternal Medicine, Galliera Hospital, Genoa, Italy
bAutoimmunity Laboratory, San Martino Hospital, Genoa, Italy
Received December 4, 2024
Accepted April 8, 2025
References
1. C, Presotto F, Furmaniak JJ. Epidemiology, pathogenesis, and diagnosis of Addison’s disease in adults. J Endocrinol Invest. 2019; 42: 1407–33.
<https://doi.org/10.1007/s40618-019-01079-6>
2. A, Benker G, Berens K, et al. An Update on Addison’s Disease. Exp Clin Endocrinol Diabetes. 2019; 127: 165–75.
3. M, Nistor C. Addison’s Disease: Diagnosis and Management Strategies. Int J Gen Med. 2023; 16: 2187–210.
<https://doi.org/10.2147/IJGM.S390793>
<PubMed>
4. M, Husebye1 ES. Approach to the patient: diagnosis of primary adrenal insufficiency in adults. J Clin Endocrinol Metab 2024; 109: 269–78.
<https://doi.org/10.1210/clinem/dgad402>
<PubMed>
5. F, Green P, Wysenbeek AJ. Myopathy in Addison’s disease. Ann Rheum Dis. 1987; 46: 81–3.
<https://doi.org/10.1136/ard.46.1.81>
<PubMed>
6. JJ, Davies AJ, Jones MK. Hyponatraemic rhabdomyolysis in Addison’s disease. Postgrad Med J. 1994; 70: 830–2.
<https://doi.org/10.1136/pgmj.70.829.830>
<PubMed>
7. EJ, Wilson R, Pringle KC. Addison’s disease presenting with an acute abdomen and complicated by cardiomyopathy. J Paediatr Child Health. 2004; 40: 644–5.
<https://doi.org/10.1111/j.1440-1754.2004.00495.x>
8. AN. Rhabdomyolysis in a patient with previously undiagnosed Addison’s disease. The Endocrinologist. 2004; 14: 101–3.
<https://doi.org/10.1097/01.ten.0000123686.15897.14>
9. M, Planinc D, Gabrić I, Katalinic D, Vucicević Z. Severe rhabdomyolysis as a first symptom in Addison’s disease. J Endocrinol Invest. 2010; 33: 206–7.
<https://doi.org/10.1007/BF03346584>
10. SY, Yong TY. Rhabdomyolysis in acute primary adrenal insufficiency complicated by severe hyponatraemia. Inter Med. 2012; 51: 2371–4.
<https://doi.org/10.2169/internalmedicine.51.7879>
11. P, Choe MS, Croxson MS. Rapid development of anterotibial compartment syndrome and rhabdomyolysis in a patient with primary hypothyroidism and adrenal insufficiency. Thyroid. 2012; 22: 651–3.
<https://doi.org/10.1089/thy.2011.0136>
12. E, Ballester-Herrera MJ, Palomo-Atance E, Sánchez-Ruiz P, Giralt-Muiña P. Hyponatremic rhabdomyolysis in Addison’s disease in a child with autoimmune polyglandular syndrome type 2. Endocrinol Nutr. 2015; 62: 511–2.
<https://doi.org/10.1016/j.endonu.2015.07.001>
13. H, Vinod NR, Ulla S, Ahmed A. Addisonian crisis complicated by rhabdomyolysis and acute kidney injury. Int J Res Med Sci. 2017; 5: 3717–9.
<https://doi.org/10.18203/2320-6012.ijrms20173592>
14. G, Milionis HJ, Elisaf M. Endocrine disorders: causes of hyponatremia not to neglect. Ann Med. 2011; 43: 179–87.
<https://doi.org/10.3109/07853890.2010.530680>
15. SS, Nagesh VK, Hunter J, Sange I. A case of severe hyponatremia in a patient with primary adrenal insufficiency. Cureus. 2021; 13(9): e17946.
16. L, Seoncg C, Dong JA, Min-Kyung K. Systemic lupus erythematosus presenting as hyponatremia-associated rhabdomyolysis: A case report. Medicine (Baltimore). 2021; 100(39): e27390.
17. JF, Jullien D, Drai E, et al. Iatrogenic rhabdomyolysis and hypothyroidism revealing Sheehan’s syndrome. Presse Med. 1994; 23: 628.
18. SA, Bonnet F, Morlat P, Beylot J. Rhabdomyolysis as a consequence of adrenal insufficiency. Am J Med. 2003; 114: 160.
<https://doi.org/10.1016/S0002-9343(02)01319-0>
19. H, Erkoc R, Sayarlioglu M, Dogan E, Kara PS, Begeik H. Sheenan syndrome presenting with acute renal failure associated with rhabdomyolysis and hyponatremia. Nephrol Dial Transplant. 2006; 21: 827–8.
<https://doi.org/10.1093/ndt/gfi234>
20. K, Noda K, Kondo K, Koide J. Rhabdomyolysis associated with hyponatremia and adrenal insufficiency. Eur J Neurol. 2006; 13: e8–e9.
<https://doi.org/10.1111/j.1468-1331.2006.01389.x>
21. Mr, Soltani P, Bozorgi MH. Panhypopituitarism presentation with acute renal failure associated with rhabdomyolysis. Pak J Med Sci. 2008; 214: 317–8.
22. L, Ruelle A, Quilici P, Del Monte P. Hypopituitarism in the elderly: two case-reports with heterogeneous presentation. Aging Clin Exp Res. 2009; 21: 76–81.
<https://doi.org/10.1007/BF03324902>
23. MB, Citarrella G, Banco R, et al. Late onset Sheehan syndrome presenting with rhabdomyolisis and hyponatremia: a case report. J Med Case Rep. 2013; 1: 227.
<https://doi.org/10.1186/1752-1947-7-227>
<PubMed>
24. L, Nagia S. A case of severe rhabdomyolysis associated with secondary adrenal insufficiency and autoimmune hepatitis. BMJ Case Rep. 2019; 12(3): e227343.
<https://doi.org/10.1136/bcr-2018-227343>
<PubMed>
25. T, Ohara N, Hirota N, et al. Isolated adrenocorticotropic hormone deficiency presenting with severe hyponatremia and rhabdomyolysis: A Case Report and Literature Review. Am J Case Rep. 2019; 20: 1857–63.
<https://doi.org/10.12659/AJCR.918427>
<PubMed>
26. C, Lai S, Xie Y, Zhang S, Lu Y. Rhabdomyolysis in a patient complicated with hypopituitarism and multiple organ dysfunction syndrome and the literature review. Am J Emerg Med. 2018; 36(9): 1723.e1–1723.e6.
<https://doi.org/10.1016/j.ajem.2018.06.019>
