A Case of Diagnostic Delay: Autoimmune Adrenalitis Mimicking Functional Gastrointestinal Disorder

Autoimmune adrenalitis is an under-recognized cause of primary adrenal insufficiency in young individuals. Its nonspecific presentation can often mimic gastrointestinal or psychiatric conditions, leading to delayed diagnosis and life-threatening adrenal crisis. We report the case of a 23-year-old male having known treated tuberculous meningitis history who presented with recurrent episodes of vomiting, generalized weakness, and altered behavior. He was hypotensive, drowsy, and had metabolic derangements, including hyponatremia and hyperkalemia. Laboratory investigations revealed low serum cortisol with elevated ACTH levels. Imaging ruled out tuberculous adrenal involvement, and the diagnosis of autoimmune adrenalitis causing primary adrenal insufficiency (Addisonian crisis) was made. The individual was handled using intravenous hydrocortisone, fluids, and supportive care, followed by oral steroid replacement. His condition improved markedly, and he was discharged on maintenance steroid therapy. Primary care physicians should consider adrenal insufficiency in young patients presenting with unexplained vomiting, weakness, or behavioral changes, especially those with a history of central nervous system tuberculosis. Early recognition and steroid replacement are critical to prevent adrenal crises and reduce morbidity.