Unmasking Addison's Disease: A Case of Acute Adrenal Crisis

Addison's disease is a rare endocrine disorder causing adrenal insufficiency and inadequate cortisol production. A 56-year-old chronic smoker presented with recurrent vomiting, abdominal pain, and severe hyponatremia. He had a 20 kg weight loss over 2 months, generalized weakness, dizziness, and hyperpigmentation. Laboratory tests showed hyponatremia (108 mEq/L), hyperkalemia (6.1 mEq/L), low fasting cortisol (0.65 µg/dL), and elevated adrenocorticotropic hormone (ACTH) (705 pg/mL). Imaging revealed bilateral adrenal enlargement and lymphadenopathy, confirming Addison's disease with adrenal crisis. Immediate IV hydrocortisone led to clinical improvement, stabilizing blood pressure and electrolyte balance. He was transitioned to oral steroids and discharged in stable condition with counseling and an emergency medical information card. This case highlights the need for early recognition and prompt treatment of adrenal crisis to prevent fatal outcomes. Increased clinician awareness can facilitate timely diagnosis and intervention, improving patient prognosis and reducing mortality risk.