Addison’s Disease Presenting with Hypercalcaemia, Acute Kidney Injury, and Anxiety

TL;DR

A woman with Addison’s disease showed unusual symptoms including high blood calcium, kidney issues, and anxiety, which improved after hormone treatment.

Contribution

This case highlights an unusual presentation of Addison’s disease with hypercalcaemia and acute kidney injury, not commonly reported in literature.

Findings

Hypercalcaemia and acute kidney injury were linked to untreated Addison’s disease.

Treatment with hydrocortisone normalized calcium levels and improved kidney function and anxiety.

Adrenal cortex antibodies confirmed autoimmune adrenal insufficiency.

Abstract

This report describes the case of a 41-year-old woman who presented with Addison’s disease, manifesting as hypercalcaemia, acute kidney injury, and anxiety. She experienced progressive weight loss, fatigue, vomiting, dizziness, and anxiety over three months. Initial laboratory investigations revealed parathyroid hormone (PTH)-independent hypercalcaemia and renal impairment. Imaging and biochemical screening excluded malignancy and other common causes of hypercalcaemia. Endocrine evaluation confirmed primary adrenal insufficiency (PAI), evidenced by markedly reduced morning cortisol, elevated adrenocorticotropic hormone (ACTH), and positive adrenal cortex antibodies. Treatment with intravenous fluids and hydrocortisone led to rapid normalisation of calcium and renal function, accompanied by significant improvement in psychiatric symptoms.