title: Atypical presentation of shock from acute adrenal insufficiency in an adolescent male.
abstract: OBJECTIVE
  To report an atypical presentation of shock and acute adrenal insufficiency in an adolescent male.
  
  
  METHODS
  A 14-year-old boy with a history of nocturnal enuresis presented with a clinical picture suggestive of septic shock refractory to aggressive fluid and vasopressor management. History and physical examination were suggestive of shock secondary to an infectious etiology, associated with skin findings of hyperpigmentation. The laboratory studies were remarkable for normal sodium, potassium, glucose, as well as normal renin levels. Hydrocortisone therapy led to improvement of his blood pressure and allowed weaning of vasopressor medications. Further laboratory studies, including adrenocorticotropic hormone stimulation test and adrenal antibodies, confirmed the diagnosis of primary adrenal insufficiency.
  
  
  CONCLUSIONS
  Acute adrenal insufficiency is an uncommon cause of shock in the adolescent population. We report a clinical presentation suggestive of shock secondary to acute adrenal insufficiency remarkable for an atypical clinical and laboratory presentation. We further provide information on the management of acute adrenal crisis.
authors.affiliation: Department of Pediatric Emergency Medicine, Children's Hospital of New York-Presbyterian, New York, NY 10032, USA. myk2102@columbia.edu
authors.forename: Maria Y
authors.initials: MY
authors.lastname: Kwok
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Scanlon
authors.forename: Arnold H
authors.initials: AH
authors.lastname: Slyper
mesh_terms: D000208:Acute Disease; D000224:Addison Disease / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D000293:Adolescent; D004635:Emergency Medicine / Q000379:methods; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use; D017495:Hyperpigmentation / Q000209:etiology; D008297:Male; D012769:Shock / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D005938:Glucocorticoids; D014662:Vasoconstrictor Agents; D006854:Hydrocortisone