Acta Med. 2025, 68: 31-36
Two Hurt More Than One: Severe Hyponatraemia and Rhabdomyolysis as Presenting Features of Addison’s Disease
, 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
Addison’s disease (AD) is characterized by non-specific symptoms and electrolyte disorders, namely hyponatraemia and hyperkalaemia; rhabdomyolysis is uncommon. AD may manifest at onset with a life-threatening adrenal crisis which is triggered by stressful events. We describe the case of a young man who was hospitalized for severe myalgia and fatigue. Severe hypotonic hyponatraemia, rhabdomyolysis and hypotension were found; hormonal assessment unexpectedly revealed primary adrenal insufficiency. Saline infusion and intravenous hydrocortisone significantly improved the patient’s condition and normalized sodium and muscle enzyme levels; thereafter, he was switched to oral steroid therapy. The autoimmune origin of AD was ascertained by the positivity of adrenal cortex autoantibodies and 21b-hydroxylase autoantibodies. The association of hyponatraemia and rhabdomyolysis may be the initial finding of an as yet unknown AD, which requires proper investigation and treatment.
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