Megaloblastic anemia in a patient with Addison s disease: A case report

Primary adrenal insufficiency (Addison s disease) is due to adrenocortical disease. This study is about a 40 year old man who had been referred to a hematologist who assessed him for anemia. He had been affected by a periodic paresthesia one month prior to his visit to the physician. According to the clinical presentation, macrocytic anemia and hypersegmentation of PMN in PBS, BMA/B was performed, which reported megaloblastic anemia. In 2001, his skin became mildly hyperpigmented, on the elbows, hands, groin and knees. In 2002, he felt weakness, had the sweats, arthralgia and myalgia. The patient was refered to a clinic and then to a hospital. But, his symptoms did not abate, therefore he was refered to the Imam-khomeini Hospital located in Tehran, and was admitted. At the hospital, new signs were detected: hypotension, hyponatremia (Na=100), raised ALT and TSH levels, and macrocytic anemia.The physician suspected primary adrenal insufficiency. More tests were performed and the diagnosis of Addison s disease was confirmed. Noticing one of the rare features in Addison s disease is megaloblastic anemia.