Delayed diagnosis of adrenal insufficiency in a patient with presumed eating disorder

Adrenal insufficiency (AI) is a rare condition that can be potentially life-threatening and manifests as an endocrine emergency. The authors present the case of a primary AI in a 13-year-old girl, previously followed in a pediatric and psychology consultation due to weight loss and anorexia, with suspected eating disorder. On admission, the patient had moderate dehydration, asthenia and palmar and gingival hyperpigmentation that raised the hypothesis of adrenal insufficiency. Laboratory results confirmed the diagnosis: hyponatremia, hyperkalemia, high adrenocorticotropic hormone (ACTH) and low cortisol levels. Treatment with hydrocortisone and fludrocortisone was started, with favorable response. The nonspecific nature of the presenting symptoms, underlines the importance of a high level of suspicion. AI is a rare diagnosis that can be misdiagnosed or misinterpreted with more frequent diseases such as eating disorders, delaying timely diagnosis and treatment.