Recurrent nocturnal hypoglycaemia as a cause of morning fatigue in treated Addison’s disease – favourable response to dietary management: a case report

BMC Endocrine Disorders

Case Report

Kristina S Petersen¹  David J Torpy²  R. Louise Rushworth³  Peter M Clifton⁴ 

[1]Dietitian, School of Pharmacy and Medical Sciences, University of South Australia, GPO Box 2471, SA 5000, Adelaide, Australia

[2]Endocrine and Metabolic Unit, Royal Adelaide Hospital, University of Adelaide, North Terrace, SA 5000, Adelaide, Australia

[3]School of Medicine, Sydney, The University of Notre Dame, 60 Oxford St., NSW 2010, Darlinghurst, Australia

[4]School of Pharmacy and Medical Sciences, University of South Australia, GPO Box 2471, SA 5000, Adelaide, Australia

关键词: Addison’s disease;    Hypoglycaemia;    Fatigue;    Dietary modification;   

DOI  :  10.1186/s12902-015-0058-6

 received in 2015-05-13, accepted in 2015-10-16,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundAddison’s disease, or primary adrenal insufficiency, is often associated with reduced well-being and fatigue despite use of currently recommended adrenal hormone replacement. Hypoglycaemia is a known manifestation of glucocorticoid deficiency, but is generally considered rare in adults and not relevant to troubling ongoing symptoms in patients with Addison’s disease.Case presentationA 43 year old woman with a three year history of Addison’s disease complained of severe morning fatigue and headaches, despite standard glucocorticoid replacement therapy in the form of thrice daily hydrocortisone and mineralocorticoid replacement with fludrocortisone. Alternative glucocorticoid replacement regimens and the addition of dehydroepiandrosterone replacement therapy had no effect. Nocturnal hypoglycaemia was suspected and a 4-day continuous glucose monitor system (CGMS) revealed hypoglycaemia (interstitial glucose < 2.2 mmol/L) between 0200–0400 h on 3 of 4 days. The patient was counselled to take an evening snack designed to ensure slow absorption of ingested carbohydrates. Nocturnal hypoglycaemia was then absent on follow up CGMS assessment. The patient noted a marked symptomatic improvement in morning symptoms, but with persistent fatigue during the day.ConclusionCurrently, the best strategy for control of non-specific symptoms in treated Addison’s disease is unknown, but it may be that investigation for hypoglycaemia and treatment, where necessary, could assist some sufferers to achieve improved wellbeing. A systematic study of this phenomenon in Addison’s disease is required.

【 授权许可】

CC BY   
© Petersen et al. 2015