Adrenocortical insufficiency in renal amyloidosis

Renal involvement in amyloidosis leads to chronic renal failure. Prognosis is poor. Although amyloid deposits are frequent in adrenal glands, symptoma tic adrenal dysfunction is uncommon. Wed report the case of a 63-year-old man with chronic renal failure (serum creatinine: 202 mu mol/L) subsequent to amyloidosis who was referred to our unit for vomiting, dehydration despite a persistent nephrotic syndrome, ac idosis, hyponatremia (121 mmol/l) and hyperkaliemia (7.1 mmol/l). A synacth en test was performed and disclosed adrenal insufficiency. Despite the init iation of substitution therapy, the patient died one month later from Addis onian crisis. Features of adrenal insufficiency may be masked by those of c hronic renal failure, emphasizing the importance of adrenal explorations in patients with chronic renal failure due to amyloidosis.