Spontaneously resolving Addison's disease

Abstract

Autoimmune Addison's disease (autoimmune primary hypoadrenalism) is generally regarded as an irreversible, progressive disease.1 Destruction of the adrenal glands leads to inadequate secretion of glucocorticoid and mineralocorticoid that requires lifelong replacement. We, however, report a case of a patient with Addison's disease who has had a spontaneous recovery. In 1990, a female patient aged 23 years had an uncomplicated first pregnancy until 32 weeks when she was admitted with nausea and abdominal pain. She had a past medical history of well-controlled epilepsy and mild asthma. She took phenytoin 450 mg a day, a regular beclomethasone 100 mcg inhaler and a salbutamol inhaler as required. On admission, she was found to have a generally tender abdomen. Her blood pressure was 110/70 mmHg with a pulse of 120/min. Initial working diagnosis was of an ascending urinary tract infection, cholecystitis or appendicitis. Her blood test showed a sodium of 126 mmol/l (ref. range: 132–144 mmol/l), potassium of 3.6 mmol/l (ref. range: 3.5–5.5 mmol/l) and creatinine of 41 μmol/l (ref. range: 35–105 μmol/l). Alkaline phosphatase was raised at 173 IU/l (ref. range: 25–75 IU/l), the transaminases were normal and the albumin was low at 28 g/l (ref. range: 30–48 g/l). Her haemoglobin …