Difficulties in diagnosis of hypocorticism in a patient with secondary amyloidosis

Detecting adrenal system problems in AA amyloidosis together with heavy proteinuria is a problem because carrying out of adrenal function tests is complicated. In AA amyloidosis with severe proteinuria, free cortisol measurements overestimate true serum cortisol values because patients may have lower levels of corticosteroid binding globulin. We present a clinical case of a patient with secondary amyloidosis and adrenal insufficiency, which was confirmed by decreased aldosterone levels and increased adrenocorticotropic hormone levels . Failure to recognize the differences between adrenal insufficiency and disease-related symptoms can have potentially life-threatening consequences in these patients. In addition, unnecessary steroid replacement therapy may cause additional problems due to the side effects of glucocorticoids.