Prolonged Fasting as a Trigger for Adrenal Crisis in a Non-Muslim Sub-Saharan African: Case Report

Abstract

Addison’s disease, or primary adrenal insufficiency, is a rare but potentially life-threatening endocrine disorder. Adrenal crisis may occur when patients are exposed to physiological stressors such as infection, trauma, or fasting, especially in the context of poor treatment adherence. Although fasting-related adrenal crisis is typically associated with Muslim patients during Ramadan, reports among non-Muslim individuals are exceedingly rare. We describe a 37-year-old black male, Christian, from sub-Saharan Africa, with a known diagnosis of Addison’s disease on oral glucocorticoid therapy, who presented with worsening asthenia, hypotension, and vomiting after a prolonged fasting period motivated by personal religious beliefs. The patient reported irregular medication adherence and had not increased the glucocorticoid dose during the fasting period. The patient was diagnosed with adrenal crisis secondary to prolonged fasting and poor adherence and improved rapidly after intravenous hydrocortisone and fluid replacement. Our case suggests that patients with Addison’s Disease are at higher risk of developing adrenal crisis during fasting periods. Close monitoring and adjustments of the therapy are recommended.