title: Adrenal crisis presenting as hypoglycemic coma.
abstract: An 18-month-old male infant presented with hypoglycemic coma and clinical signs of bronchopneumonia. He was suspected of suffering from septic shock. The patient progressed to irreversible multiple organ failure before the diagnosis of adrenal crisis was established. Plasma levels of ACTH and cortisol remained undetectable. Renin and aldosterone were normal. An autopsy failed to demonstrate any adrenal gland cortical tissue. Immunohistochemical staining demonstrated the presence of all pituitary hormones except ACTH, establishing the diagnosis of isolated ACTH deficiency. Intensive care clinicians should consider adrenal crisis in non-diabetic children with hypoglycemia and rapid circulatory deterioration.
authors.affiliation: Department of Intensive Care, Children's Hospital, University of Zurich, Steinwiesstrasse 75, CH-8032 Zurich, Swizerland. jfischer@kispi.unizh.ch
authors.forename: J E
authors.initials: JE
authors.lastname: Fischer
authors.forename: T
authors.initials: T
authors.lastname: Stallmach
authors.forename: S
authors.initials: S
authors.lastname: Fanconi
mesh_terms: D000302:Adrenal Cortex / Q000473:pathology; D000324:Adrenocorticotropic Hormone / Q000097:blood / Q000172:deficiency*; D003128:Coma / Q000209:etiology* / Q000503:physiopathology; D017809:Fatal Outcome; D005947:Glucose / Q000627:therapeutic use; D006801:Humans; D007003:Hypoglycemia / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D007223:Infant; D008297:Male
chemical_list: D000324:Adrenocorticotropic Hormone; D005947:Glucose