Autoimmune adrenalitis in adolescents in Germany: a series of 4 cases

This case report summarises clinical findings in four adolescents (aged 14-17 years) diagnosed with autoimmune adrenalitis at a German University Children's Hospital between 2019 and 2025.

Clinical presentation varied and included fatigue, arterial hypotension, depressive symptoms, hyperpigmentation of the skin, and in one case acute kidney failure associated with acute viral infection. All patients showed hyponatraemia, reduced cortisol levels in serum and elevated adrenocorticotropic hormone concentrations at diagnosis. Autoimmune adrenalitis was confirmed in all patients by the presence of autoantibodies against the adrenal cortex. Interestingly, three of the four cases were diagnosed within a period of only 18 months.

Our case series of autoimmune adrenalitis may suggest a potential increase  in the annual incidence among adolescents. The clinical diversity of symptoms at diagnosis ranging from depression to acute kidney failure was striking. Since delayed diagnosis may lead to life-threatening complications, awareness of clinical variability is essential for physicians to achieve timely diagnosis. Cortisol levels should be routinely measured in patients with unclear fatigue and hyponatraemia.