A Challenging Case of Primary Adrenal Insufficiency Mistakenly Labeled as Pre-diabetes

Misa Ito and Alba Morales*

Department of Internal Medicine/Pediatrics, University of Kentucky, Lexington, Kentucky, United States Department of Pediatrics-Endocrine/Metabolic, University of Kentucky, Lexington, Kentucky, United States

^*Correspondance to: Alba Morales 

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Abstract:

Primary adrenal insufficiency (PAI) is a rare endocrine disorder with an incidence of approximately 10-15 per 100,000 individuals. It presents insidiously with non-specific symptoms, often leading to delayed diagnosis. We report the case of a 14-year-old girl with a 14-month history of recurrent nausea, vomiting, abdominal pain, weight loss, hyperpigmentation and fatigue. Physical examination revealed hyperpigmentation in the neck and axillary areas, initially mistaken for acanthosis nigricans. Laboratory results showed a low cortisol level, elevated ACTH, and plasma renin activity, confirming PAI. The patient’s symptoms, including gastrointestinal distress and salt craving, were attributed to both glucocorticoid and mineralocorticoid deficiency. Treatment with hydrocortisone and fludrocortisone led to rapid clinical improvement, with resolution of symptoms and weight gain. This case highlights the diagnostic challenge of distinguishing PAI from other conditions with overlapping symptoms, particularly in the presence of skin and mucosal hyperpigmentation. Early recognition and appropriate testing are critical to prevent misdiagnosis and ensure prompt management.

Keywords:

Pre-diabetes

Cite the Article:

Ito M, Morales A. A Challenging Case of Primary Adrenal Insufficiency Mistakenly Labeled as Pre-diabetes. Ann Clin Case Rep. 2025; 10: 2720..