Adrenal Crisis Triggered by Endogenous Thyrotoxicosis: Case Series

Objective Describe a group of patients who presented with thyrotoxicosis and were also found to have adrenal insufficiency. Methods Patient cases were collected over the past year at University of North Carolina at Chapel Hill. Their clinical, laboratory, exam, and imaging findings are presented along with a review of the literature. Results Four patients presented to the emergency room with thyrotoxicosis and were diagnosed with concomitant adrenal insufficiency; three of the four were found to have adrenal crisis at presentation. Patient 1 was diagnosed with recurrent Graves thyrotoxicosis, then was subsequently diagnosed with secondary adrenal insufficiency due to lymphocytic hypophysitis. Patients 2 through 4 were given a new diagnosis of Graves thyrotoxicosis, then were subsequently found to also have primary adrenal insufficiency. Conclusion It is important to recognize the possibility of adrenal insufficiency in patients with autoimmune hyperthyroidism who have an atypical presentation. Thyrotoxicosis can trigger adrenal crisis in patients with concomitant adrenal insufficiency; thus, any delay in diagnosis is potentially life threatening.