Addisonian Crisis Complicated by Relative Hypertension, Edema, and Acute Streptococcus Hemolyticus Infection of the Throat

Abstract

The progress in the treatment of Addison's disease received considerable impetus with the synthetic preparation of desoxycorticosterone acetate by Steiger and Reichstein (1). Clinical reports began to appear attesting to its efficacy in this disease (2–5) and, indeed, the enthusiasm manifested in these reports was well merited. The patients in Addisonian crisis responded satisfactorily and the distortion in the blood electrolyte pattern so characteristic of the crisis was promptly corrected. However, toxic manifestations, such as hypertension, edema, and heart failure resulting from overdosage with the drug were observed (4, 5). We have under our observation a patient with Addison's disease who developed acute adrenal insufficiency while under treatment with desoxycorticosterone acetate. The crisis was complicated, and perhaps even precipitated by a hemolytic streptococci tonsillitis. The picture was unusual in that the adrenal insufficiency occurred while the patient had a relative hypertension and diffuse edema. Treatment with large doses of cortical extract, intravenous fluids, and sulfadiazine resulted in recovery.