Clinical Mysteries • Endocrinology
The Abdominal Pain With a “Clean” Scan
The presentation
Repeated imaging found no surgical cause for abdominal pain, vomiting and weakness.
The first explanation was plausible, but the pattern did not fully fit. A deliberate second look focused on physiology, medication/exposure history, serial observations and the clue that the initial diagnosis could not explain.
The turn
Hypotension, hyponatraemia and hyperkalaemia redirected the work-up.
Diagnosis
Adrenal crisis
Why this case matters
When anatomy is unrevealing, revisit physiology.
Take-home message: When the clinical course contradicts the working diagnosis, stop escalating the same treatment and rebuild the problem from first principles.