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Ketoacidosis and adrenocortical insufficiency
Cristian Palmiere1, Sébastien de Froidmont, Patrice Mangin
1University Centre of Legal Medicine, Rue du Bugnon 21, 1011, Lausanne, Switzerland.
Journal of Forensic Sciences
|March 29, 2014
Summary
This autopsy case study highlights acute adrenocortical insufficiency as the cause of death in a young woman with polyendocrine disorder. Postmortem biochemistry confirmed critical hormone deficiencies, suggesting ketoacidosis precipitated the crisis.
Area of Science:
- Endocrinology
- Forensic Pathology
- Clinical Biochemistry
Background:
- A 27-year-old female with a history of polyendocrine disorder presented with chronic adrenocortical insufficiency.
- The case underscores the complexity of managing and diagnosing adrenal insufficiency in individuals with multiple endocrine abnormalities.
Observation:
- Postmortem serum analysis revealed significantly low levels of aldosterone, cortisol, and dehydroepiandrosterone.
- Urine tests showed decreased cortisol and 17-hydroxycorticosteroid.
- Vitreous humor analysis indicated reduced sodium and elevated 3-beta-hydroxybutyrate and C-reactive protein.
Findings:
- The primary cause of death was determined to be acute adrenocortical insufficiency.
- Fasting ketoacidosis was identified as a likely precipitating factor for the Addisonian crisis.
- Exclusion of traumatic causes and third-party involvement was confirmed.
Implications:
- This case emphasizes the critical role of comprehensive postmortem biochemical investigations.
- Thorough analysis aids in accurately determining the pathophysiological mechanisms contributing to death.
- It highlights the importance of recognizing and managing metabolic derangements in adrenal insufficiency.
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