Sudden Death in Addison’s Disease: Lead Poisoning-like Gum Appearance

CASE STUDY, July 2011, VOL I ISSUE IV, ISSN 2042-4884
10.5083/ejcm.20424884.32 , Cite or Link Using DOI
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Boonsak Hanterdsith, Pongsak Mahanupab

ABSTRACT

Fatal Addison’s disease is rarely found in forensic cases. We report the sudden and unexplained death of a 51-year-old woman on arrival at the emergency room. Previous clinical history revealed frequent hypotension, hyponatremia and persistent hyperpigmented skin consistent with Addison’s disease. However, the diagnosis could only be made during autopsy. The adrenal gland was completely
absent. Postmortem blood cortisol was very low (0.86 μg/dL). The thyroid gland showed Hashimoto thyroiditis. The probable cause of Addison’s disease in this case was autoimmune adrenalitis.

INTRODUCTION

Chronic adrenocortical insufficiency is an uncommon disorder resulting from progressive destruction of the adrenal cortex. Clinical features include progressive anaemia, bronze skin pigmentation, severe weakness, hypotension, nausea, vomiting, anorexia, weight loss and hypoglycemia. Hyponatremia is observed in about 80% of acute cases whereas less than half present with hyperkalemia. These clinical features were first reported as Addison’s disease in “On the Constitutional and Local Effects of Disease of the Supra-renal Capsules” in the London Medical Gazette, 1849 by Thomas Addison.