"Case Report – Unexplained Vomiting Causing Wasting Syndrome in a Young Male"

Background: Adrenal insufficiency (AI) is a life-threatening condition marked by insufficient glucocorticoid production. It often presents with non-specific symptoms such as weight loss, fatigue, vomiting, and bradycardia. Sinus bradycardia can sometimes be the first clinical clue pointing toward a severe underlying condition like AI. Case Presentation: A 30-year-old healthy Hindu male presented with a 4-month history of progressive weight loss, generalized weakness, and recurrent postprandial vomiting. Despite a preserved appetite, the patient experienced vomiting immediately after consuming solid food, suggesting partial obstruction, though no obvious signs of pyloric stenosis were observed. Imaging studies, including USG and CT scans, excluded other causes such as cholecystitis or malignancy. After several misdiagnoses, including suspected duodenal obstruction, a triad of unexplained vomiting, wasting with preserved appetite and bradycardia led to the diagnosis of adrenal insufficiency. Laboratory tests revealed decreased serum ACTH and cortisol levels. The patient was treated with IV hydrocortisone, followed by oral corticosteroids, leading to a significant improvement in symptoms. Conclusion: This case emphasizes the importance of considering adrenal insufficiency in patients with unexplained vomiting, wasting with preserved appetite and sinus bradycardia. The presence of sinus bradycardia should heighten suspicion for adrenal insufficiency, and timely diagnosis can significantly improve clinical outcomes.