—Howard Baum, MDA 35-YEAR-OLD white man with known primary adrenal insufficiency presented to the endocrinology clinic complaining of clumsiness in the legs.The patient was well until age 19 years, when he experienced three episodes of fever, nausea, vomiting, diarrhea, and extreme fatigue, each more severe than the previous. On the third occasion, the diagnosis of adrenal insufficiency was made based on low serum cortisol levels before and after corticotropin stimulation. Daily oral adrenal steroid replacement therapy was begun. The patient generally was well in subsequent years, increasing his dose of cortisone acetate when suffering an intercurrent illness. He remained tan throughout the year.Several months before this presentation the patient noted clumsiness in his lower extremities. His athletic ability, while never outstanding, declined. He noticed stiffness in the legs after prolonged sitting and commented that there was diminished sensation in the feet. There was no weakness
Ladenson PW. Adrenoleukodystrophy. JAMA. 1989;262(11):1504–1506. doi:10.1001/jama.1989.03430110094035
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