03 July 2023
: Case report 
An 81-Year-Old Man Presenting with Asthenia and Anorexia After an Alcohol-Induced Hypoglycemic Coma and a Diagnosis of Central Adrenal Insufficiency: A Case Report
Rare coexistence of disease or pathology
Nobumasa Ohara1ABCDEF*, Naoko Hirota2B, Toshinori Takada
3D, Takashi Tani4D, Kenshi Terajima4D, Tetsutaro Ozawa4D, Yasuhiro Seki5D, Katsuhiko Akiyama5D, Yuichiro Yoneoka5ACDF
DOI: 10.12659/AJCR.939840
Am J Case Rep 2023; 24:e939840
Table 1. Laboratory test results.
| Admission to a regional hospital | Transfer to our hospital (2 weeks later) | |||
|---|---|---|---|---|
| Hematology | ||||
| Red blood cells (×10/μL) | 363 | (435–555) | 317 | (435–555) |
| Hemoglobin (g/dL) | 11.7 | (13.7–16.8) | 10.2 | (13.7–16.8) |
| Hematocrit (%) | 31.7 | (40.7–50.1) | 28.3 | (40.7–50.1) |
| White blood cells (/μL) | 6300 | (3300–8600) | 5100 | (3300–8600) |
| Neutrophils (%) | 78.4 | 32.3 | ||
| Lymphocytes (%) | 15.2 | 44.7 | ||
| Eosinophils (%) | 2.1 | 17.5 | ||
| Basophils (%) | 0.2 | 0.8 | ||
| Monocytes (%) | 4.1 | 4.7 | ||
| Platelets (×10/μL) | 13.6 | (15.8–34.8) | 14.4 | (15.8–34.8) |
| Blood chemistry | ||||
| Total protein (g/dL) | 5.7 | (6.7–8.3) | 5.9 | (6.6–8.1) |
| Albumin (g/dL) | 3.2 | (3.8–5.3) | 3.3 | (4.1–5.1) |
| Aspartate aminotransferase (IU/L) | 35 | (8–38) | 40 | (13–30) |
| Alanine aminotransferase (IU/L) | 18 | (4–44) | 26 | (10–42) |
| Gamma-glutamyl transpeptidase (IU/L) | 19 | (0–50) | 15 | (13–64) |
| Urea nitrogen (mg/dL) | 6.3 | (8.0–20.0) | 9.1 | (8.0–20.0) |
| Creatinine (mg/dL) | 0.64 | (0.61–1.10) | 0.81 | (0.65–1.07) |
| Uric acid (mg/dL) | N.D. | 1.7 | (3.7–7.8) | |
| Sodium (mEq/L) | 116 | (135–147) | 124 | (135–145) |
| Potassium (mEq/L) | 4.1 | (3.5–4.8) | 3.9 | (3.5–4.8) |
| Chloride (mEq/L) | 84 | (98–108) | 91 | (98–108) |
| Triglycerides (mg/dL) | N.D. | 59 | (50–149) | |
| Fasting plasma glucose (mg/dL) | 89 | (70–109) | 61 | (70–109) |
| Plasma osmolality (mOsm/kg) | 242 | (275–290) | 249 | (275–290) |
| C-reactive protein (mg/dL) | 0.32 | (0–0.30) | 0.82 | (0–0.14) |
| Endocrinology | ||||
| Arginine vasopressin (pg/mL) | 4.5 | (< 2.8) | 0.7 | (< 2.8) |
| Adrenocorticotropic hormone (pg/mL) | 45.0 | (7.2–63.3) | 41.7 | (7.2–63.3) |
| Cortisol (μg/dL) | 18.0 | (4.5–21.1) | 1.1 | (4.5–21.1) |
| Plasma renin activity (ng/mL/h) | 0.4 | (0.2–2.3) | < 0.2 | (0.2–2.3) |
| Aldosterone (ng/dL) | 6.4 | (3.0–15.9) | 8.6 | (3.0–15.9) |
| Free triiodothyronine (pg/mL) | N.D. | 2.47 | (2.30–4.00) | |
| Free thyroxine (ng/dL) | N.D. | 1.04 | (0.90–1.70) | |
| Urine chemistry | ||||
| Urinary osmolality (mOsm/kg) | 706 | (50–1300) | 450 | (50–1300) |
| Urinary sodium (mEq/L) | 140 | (88–285) | 138 | (88–285) |
| Blood and urine samples were collected in the morning, with the patient in a supine position, on the second day after admission to a regional hospital and again after being transferred to our hospital (2 weeks later). N.D. – not determined. | ||||