D. Philbin and E. Moylett (2014). 'Diabetic ketoacidosis may not always be the answer…'. BMJ case reports, 2014. https://doi.org/10.1136/bcr-2014-206344

PubMed 25315804

[Abstract]
We present the interesting case of a 9-year-old boy with type 1 diabetes mellitus. He presented to the emergency department extremely unwell and the diagnosis of diabetic ketoacidosis was promptly performed. He was started on the local diabetic ketoacidosis (DKA) protocol, but his recovery remained slow. The possibility of an underlying pathology was later addressed and led to the diagnosis of primary adrenal insufficiency. This case highlights the difficulty in diagnosis of childhood Addison's disease due to its vague and non-specific symptoms and the importance of a high degree of clinical suspicion. This case also highlights the existence of autoimmune polyendocrine syndromes and the ongoing need to increase awareness and screening of these conditions.