Adrenocortical insufficiency

Primary adrenocortical insufficiency is a rare disease which may present wi th protean clinical symptoms and signs. At one end of the spectrum is the p atient with a long clinical history with marked pigmentation and documented episodes of crises which may follow relatively minor viral illnesses. The other extreme is illustrated by patients with a rapid deterioration in heal th culminating in unexpected or unexplained death, in the latter instances, the forensic pathologist may well be involved, and the case will present a significant challenge to diagnosis. We report 5 cases of primary and secon dary adrenocortical insufficiency seen at the Victorian Institute of Forens ic Medicine in 1 year. One adult man presented as a case of sudden unexplai ned death. In 2 cases, the diagnosis of adrenocortical insufficiency was ra ised following postmortem examination and confirmed by the treating physici an following further consultation. In the remaining 2 cases, the diagnosis was known prior to postmortem examination and the diagnosis confirmed.