DEPRESSION IS NOT ALWAYS THE ANSWER: A ADRENAL INSUFFICIENCY CASE!

Introduction/Objectives: Adrenal insufficiency is the inadequate secretion of cortisol from the adrenal gland. In primary adrenal insufficiency, the pathophysiological problem is a malfunction of the adrenal cortex. In secondary adrenal insufficiency, the problem started with decreased ACTH stimulation of the adrenal cortex. The most common symptoms include weakness, fatigue, anorexia, weight loss, nausea, vomiting, abdominal pain or diarrhea. This disease is rare, but potentially fatal, so it require an attempted treatment. The non-specificity of the symptoms difficult diagnosis, which is often delayed. The objective of this case is to give more visibility to adrenal insufficiency, to become easier to recognize/diagnose this pathology for early intervention. Case Description: A 70 year-old man search family doctor (GP) by fatigue, nausea, anorexia, diarrhea and weight loss. The doctor asked a endoscopy, colonoscopy (both normal), brain and abdominal computed tomography (normal), and celiac disease markers (negatives). Without any alteration in exams (with maintain symptoms), the GP asked a psychiatrist evaluation: diagnosed depression and medicated without improvements. Symptoms were maintained for one year, so he was observed by Internal Medicine and admitted for study: was found low ACTH and cortisol values, having been diagnosed with adrenal insufficiency. Began treatment with hydrocortisone, which precipitated a psychosis at the beginning. With decrease of dose, the patient improved and is currently without complains. Conclusion: Adrenal Insufficiency should be present as a possible diagnosis in cases with no specificity symptoms. It is crucial to make the diagnosis to provide a premature medical treatment because this disease is potentially fatal.