Neurological Symptom in a Case of Adrenal Insufficiency

Around 50% of patients with Addison disease (AD) have other autoimmune disorders. Neuropsychiatric symptoms may be presenting features of an Addisonian crisis or may be presented in patients with adrenoleukodystrophy (ALD) or Hashimoto encephalopathy; that these disorders are associated with primary adrenal insufficiency (AI). Nearly 5% of individuals with autoimmune AD develop pernicious anemia. X-linked ALD (X-ALD) is an inherited neurodegenerative disorder; a frequent but under-recognized cause of primary adrenocortical insufficiency. The classic picture of Vitamin B12 deficiency is subacute combined degeneration of the dorsal (posterior) and lateral spinal columns. The neuropathy is symmetrical, affects the legs more than the arms. It begins with paresthesia and ataxia and can progress to severe weakness, spasticity, paraplegia, even fecal, and urinary incontinence. We report a case of autoimmune AI who had presented with some neurologic symptoms. The challenging point was differentiating between X-ALD and other neurological syndromes that have an association with AI.