New-onset Adrenal Insufficiency Presenting with Adrenal Shock in a Pediatric Patient

This case report describes new-onset adrenal insufficiency and adrenal shock in an 11-year-old male complaining of two weeks of malaise and weight loss. He was lethargic and pale in appearance. Work-up revealed hypoglycemia and hyponatremia without evidence for an infectious process. He was transported via a pediatric critical care transport team to a regional pediatric intensive care unit (PICU). He required intravenous fluids and vasopressors prior to arrival in the PICU. He had generalized weakness, and hyperpigmentation of his face and extremities. Adrenal insufficiency was suspected, and glucocorticoid administration led to improvement. Cortisol level was undetectable. At time of discharge, he was prescribed daily glucocorticoid and mineralocorticoid replacement, along with a stress dose glucocorticoid plan.