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Hypoglycaemia in type 2 diabetes mellitus is typically attributed to antidiabetic medications; however, the diagnosis of adrenal insufficiency, although rare, should be considered in severe or prolonged hypoglycaemia. The clinical manifestations of adrenal insufficiency can be non‐specific and resemble those caused by opioid therapy and the underlying conditions requiring opioid treatment. Other causes of adrenal insufficiency such as space‐occupying lesions, pituitary apoplexy, head trauma and drug‐induced adrenal insufficiency, including exogenous steroids, were absent in the patient and should be excluded. Notably, the patient's serum cortisol level was strikingly low despite OCP use, which elevates total cortisol concentrations by increasing corticosteroid‐binding globulin.

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Authors: Michael Do, Annabelle G Hayes and Malgorzata M Brzozowska

Article Type: Medical Education