title: Liver involvement and abnormal iron variables in undiagnosed Addison's disease.
abstract: OBJECTIVE
  To describe a case of untreated Addison's disease manifesting as severe gastrointestinal symptoms, persistently increased liver enzymes, substantially increased ferritin, and hepatic iron deposition and to document changes in these variables after corticosteroid replacement.
  
  
  METHODS
  We thoroughly reviewed the clinical history and results of laboratory tests before and after treatment in a 23-year-old man during a period of 18 months. The relevant medical literature was also reviewed.
  
  
  RESULTS
  The study patient had frequent episodes of severe abdominal symptoms, hemodynamic instability, and electrolyte imbalance. He underwent extensive laboratory investigations and was prescribed various treatment regimens. Increased levels of serum transaminases, ferritin, and transferrin saturation led to a liver biopsy, which showed lymphocytic infiltration and increased iron deposition. Eventually, cosyntropin stimulation (250 microg) confirmed the presence of adrenal insufficiency, and these abnormalities resolved after institution of daily administration of glucocorticoids and mineralocorticoids.
  
  
  CONCLUSIONS
  Addison's disease can be a cause of unexplained hypertransaminasemia and profoundly increased ferritin levels. These changes are reversible but may lead to diagnostic confusion and delay in commencement of lifesaving corticosteroid therapy.
authors: Internal Medicine and Endocrine Associates of Augusta, P.C., Georgia, USA.
authors: A A
authors: AA
authors: Rizvi
authors: J G
authors: JG
authors: Kerrick
mesh_terms: D000224:Addison Disease / Q000097:blood* / Q000473:pathology*; D000328:Adult; D005293:Ferritins / Q000097:blood*; D006801:Humans; D008099:Liver / Q000473:pathology*; D008297:Male; D000637:Transaminases / Q000097:blood; D014168:Transferrin / Q000032:analysis
chemical_list: D014168:Transferrin; D005293:Ferritins; D000637:Transaminases