[Hypoglycaemic ketoacidosis - an endocrine emergency]

A 20-year-old female patient was admitted via the medical emergency service to an accident and emergency department. Apart from obesity, no pre-existing medical conditions were known.The patient presented with hypotension, tachycardia, fever, somnolence and a brownish complexion. Computerised tomography revealed a diffuse cerebral oedema. Laboratory investigations demonstrated elevated inflammatory biomarkers, hyponatremia, renal failure, combined metabolic acidosis with severe ketonemia and slight lactatemia, primary hypothyroidism and adrenal failure. No indications for diabetes mellitus were obtained. The source of the infection could not be identified.Acute Addisonian crisis in the course of sepsis as the primary manifestation of autoimmune pluriglandular syndrome (APS) type 2.Due to treatment with initial hydrocortisone and broad-spectrum antibiotics, supportive measures and levothyroxine (in the further course) the situation could be stabilised within several days.The combination of the metabolism of starvation and endocrine diseases can lead to ketoacidosis in the absence of diabetes. The differential diagnosis of adrenal failure should be considered in this situation.