title: Ketoacidosis and adrenocortical insufficiency.
abstract: We herein report an autopsy case involving a 27-year-old Caucasian woman suffering from chronic adrenocortical insufficiency with a background of a polyendocrine disorder. Postmortem biochemistry revealed pathologically decreased aldosterone, cortisol, and dehydroepiandrosterone levels in postmortem serum from femoral blood as well as decreased cortisol and 17-hydroxycorticosteroid in urine. Decreased vitreous sodium and increased 3-beta-hydroxybutyrate and C-reactive protein concentrations were observed. The cause of death was determined to be acute adrenocortical insufficiency. Fasting ketoacidosis was postulated to have precipitated the Addisonian crisis. Traumatic causes of death and third-party involvement were excluded. The case highlights the importance of systematically performing exhaustive postmortem biochemical investigations to formulate appropriate hypothesis regarding the pathophysiological mechanisms involved in the death process.
authors.affiliation: University Centre of Legal Medicine, Rue du Bugnon 21, 1011, Lausanne, Switzerland.
authors.forename: Cristian
authors.initials: C
authors.lastname: Palmiere
authors.forename: Sébastien
authors.initials: S
authors.lastname: de Froidmont
authors.forename: Patrice
authors.initials: P
authors.lastname: Mangin
authors.forename: Dominique
authors.initials: D
authors.lastname: Werner
authors.forename: Johannes A
authors.initials: JA
authors.lastname: Lobrinus
mesh_terms: D015065:17-Hydroxycorticosteroids / Q000652:urine; D020155:3-Hydroxybutyric Acid / Q000378:metabolism; D000224:Addison Disease / Q000150:complications*; D000328:Adult; D000450:Aldosterone / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D003687:Dehydroepiandrosterone / Q000097:blood; D005215:Fasting; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000652:urine; D007662:Ketosis / Q000209:etiology*; D012964:Sodium / Q000378:metabolism; D014822:Vitreous Body / Q000378:metabolism
chemical_list: D015065:17-Hydroxycorticosteroids; D003687:Dehydroepiandrosterone; D000450:Aldosterone; D002097:C-Reactive Protein; D012964:Sodium; D020155:3-Hydroxybutyric Acid; D006854:Hydrocortisone
keywords: Addisonian crisis; adrenocortical insufficiency; fasting; forensic sciences; ketoacidosis; postmortem biochemistry