Infections and gender: clues for diagnosis of adrenal insufficiency-a case report and a review of the literature

Abstract

The clinical presentation of adrenal insufficiency, a condition causing adrenal hormone deficiency, is characterised by non-specific symptoms and signs: consequently, an important diagnostic delay is often evident which correlates with an increased mortality. This case report shows how the clustering of some symptoms and signs may hamper the diagnostic suspicion for this condition: serum electrolyte alterations and weight loss, when associated to recurrent infections and, in female patients, an empty sella may further guide the clinician towards a diagnosis of adrenal insufficiency. Accordingly, a clinical approach taking into account gender medicine could improve the diagnostic workup.

Keywords: Adrenal insufficiency; Empty sella syndrome; Gender medicine; Infection.

Fig. 1

Encephalic MRI with contrast enhancement from which a picture of partial empty sella (circle) emerges with thinned and displaced parenchyma of the pituitary gland on the sella floor. A normal hyperintense neurohypophysis with the pituitary peduncle (arrow) regularly contrast enhanced, pushed back and deviated to the left. a: T2 sequence, coronal; b: T1 sequence with CE, coronal; c: T1 sequence with CE, axial; d: T1 sequence with CE, sagittal