Recurrent Acute gastroenteritis with septic shock and acute kidney injury detected as Addison’s disease after 5 years

Introduction: Addison's disease is a rare endocrinal disorder, with several oral and systemic manifestations. A variety of pathological processes may cause Addison's disease. Classically, hyperpigmentation is associated with the disease, and intraoral pigmentation is perceived as the initial sign and develops earlier than the dermatological pigmentation. The symptoms of the disease usually progress slowly and an event of illness or accident can make the condition worse and may lead to a life-threatening crisis. In this case, several oral as well as systemic manifestation of the Addison's disease was encountered. A 45 year old male became acutely unwell and had a background of recurrent admissions in past for AGE like illness requiring pressor support and in between had generalized weakness,nausea,weight loss and fatigue. He had an acute diarrhoeal illness which didn’t respond completely to intravenous fluids and antibiotics. In view of patient having such episodes in past 5 years and features of hyperpigmentation and generalized weakness, nausea and weight loss. With this background , patient was evaluated for adrenal insufficiency which was confirmed by basal cortisol levels and Short synacthen test(SST). Conclusion: Addison's disease can remain unrecognised until precipitated by acute stress.