title: [Ears "made of stone" - unusual secondary phenomenon of undersubstituted adrenal insufficiency].
abstract: METHODS
  A 69-year-old man was admitted with cough, fever and dyspnea. For years, an adrenal insufficiency has been substituted with low-dose hydrocortisone. The hypotensive and tachycardic patient exhibited remarkable stony hard ears.
  
  
  METHODS
  Elevated inflammatory markers and the clinical picture point to a pulmonary focus of infection. Radiographs of the ears show trabecular structures as a sign of true ossification.
  
  
  METHODS
  Addisonian crisis due to pulmonary infection was treated successfully with steroids, antibiotics and intravenous fluids. The auricular ossification was interpreted as a secondary phenomenon of undersubstituted adrenal insufficiency.
  
  
  CONCLUSIONS
  Adrenal insufficiency should be considered when auricular ossification is encountered. The pathogenesis of this phenomenon is complex and not well understood.
authors.affiliation: Klinik für Innere Medizin, Regionalspital Emmental, Burgdorf, Schweiz. j.c.richter_md@hotmail.com
authors.forename: Jens Christian
authors.initials: JC
authors.lastname: Richter
authors.forename: B
authors.initials: B
authors.lastname: Chappuis
mesh_terms: D000224:Addison Disease / Q000150:complications* / Q000188:drug therapy; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002114:Calcinosis / Q000175:diagnosis / Q000209:etiology*; D002356:Cartilage / Q000000981:diagnostic imaging / Q000473:pathology; D004427:Ear Diseases / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage* / Q000009:adverse effects; D007877:Legionnaires' Disease / Q000150:complications / Q000175:diagnosis; D008297:Male; D009999:Ossification, Heterotopic / Q000175:diagnosis / Q000209:etiology*; D011859:Radiography
chemical_list: D000893:Anti-Inflammatory Agents; D006854:Hydrocortisone