Case 10-1987

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Abstract
Presentation of CaseA 59-year-old woman was admitted to the hospital because of polyneuropathy and weight loss.She was well until seven years earlier, when she began to notice gradual weight loss. During the three years before admission chronic anemia was noted; slowly worsening ascending peripheral neuropathy developed and did not respond to injections of vitamin B12. A persistent hyperchloremic acidosis was found, with potassium levels that ranged as high as 6.4 mmol per liter. Medical evaluation elsewhere showed increased pigmentation and orthostatic hypotension. The fasting serum cortisol was normal, as were the results of an adrenocorticotropic hormone . . .