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Ketoacidosis and Adrenocortical Insufficiency
Author(s) -
Palmiere Cristian,
Froidmont Sébastien,
Mangin Patrice,
Werner Dominique,
Lobrinus Johannes A.
Publication year - 2014
Publication title -
journal of forensic sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.715
H-Index - 96
eISSN - 1556-4029
pISSN - 0022-1198
DOI - 10.1111/1556-4029.12446
Subject(s) - adrenal insufficiency , adrenocortical insufficiency , autopsy , medicine , endocrinology , aldosterone , dehydroepiandrosterone sulfate , cause of death , hydrocortisone , urine , pathophysiology , physiology , hormone , disease , androgen
We herein report an autopsy case involving a 27‐year‐old C aucasian woman suffering from chronic adrenocortical insufficiency with a background of a polyendocrine disorder. Postmortem biochemistry revealed pathologically decreased aldosterone, cortisol, and dehydroepiandrosterone levels in postmortem serum from femoral blood as well as decreased cortisol and 17‐hydroxycorticosteroid in urine. Decreased vitreous sodium and increased 3‐beta‐hydroxybutyrate and C ‐reactive protein concentrations were observed. The cause of death was determined to be acute adrenocortical insufficiency. Fasting ketoacidosis was postulated to have precipitated the A ddisonian crisis. Traumatic causes of death and third‐party involvement were excluded. The case highlights the importance of systematically performing exhaustive postmortem biochemical investigations to formulate appropriate hypothesis regarding the pathophysiological mechanisms involved in the death process.