[Hypoglycaemic ketoacidosis - an endocrine emergency]

Area of Science:

• Endocrinology
• Internal Medicine
• Critical Care Medicine

Background:

• Autoimmune pluriglandular syndrome (APS) type 2 is a rare autoimmune disorder.
• Acute Addisonian crisis is a life-threatening adrenal insufficiency.
• Sepsis can precipitate or unmask underlying endocrine disorders.

Purpose of the Study:

• To report a case of APS type 2 presenting as an acute Addisonian crisis during sepsis.
• To illustrate the diagnostic challenges and management of this rare condition.
• To highlight the potential for non-diabetic ketoacidosis in patients with endocrine disorders.

Main Methods:

• Case report of a 20-year-old female patient.
• Clinical presentation: hypotension, tachycardia, fever, somnolence, cerebral edema.
• Laboratory findings: elevated inflammatory markers, hyponatremia, renal failure, metabolic acidosis, ketonemia, hypothyroidism, adrenal failure.

Main Results:

• The patient was diagnosed with acute Addisonian crisis secondary to sepsis, as a manifestation of APS type 2.
• Treatment with hydrocortisone, broad-spectrum antibiotics, and levothyroxine led to stabilization.
• The patient recovered within several days.

Conclusions:

• Autoimmune pluriglandular syndrome type 2 can present acutely during sepsis.
• Ketoacidosis can occur in the absence of diabetes mellitus, particularly in patients with coexisting endocrine diseases and starvation metabolism.
• Adrenal failure should be considered in the differential diagnosis of metabolic acidosis with ketonemia.