MON-032 Intractable Hiccups in Adrenal Insufficiency: A Rare Symptom with Diagnostic Implications

Abstract Disclosure: N. Bapat: None. G. Dawood: None. Introduction: Hiccups, caused by involuntary diaphragmatic spasms, are typically benign but can occasionally signal underlying pathology. Intractable hiccups as a symptom of adrenal insufficiency are rare, with limited reports in the literature. We present a compelling case of intractable hiccups linked to central adrenal insufficiency, highlighting its diagnostic and therapeutic implications. Case Presentation: A 64-year-old male with a history of a 2 cm non-secretory pituitary macroadenoma underwent surgical resection in 2014. Postoperatively, he developed central adrenal insufficiency and was managed with hydrocortisone replacement until 2015, when a morning cortisol of 8.8 mcg/dL prompted cessation of therapy. He continued on levothyroxine and testosterone for central hypothyroidism and hypogonadotropic hypogonadism. In September 2023, he presented with a two-week history of fatigue, non-bloody diarrhea, and persistent hiccups. Emergency department evaluation revealed hyponatremia (sodium 132 mmol/L) and elevated lactate (3.1 mmol/L), which were attributed to a gastrointestinal illness. He received intravenous fluids and was discharged. While diarrhea resolved, hiccups and systemic symptoms persisted, prompting an endocrinology consultation. Morning cortisol was 1.4 mcg/dL, and ACTH was 7.7 pg/mL, confirming central adrenal insufficiency. Hydrocortisone was restarted at 10 mg in the morning and 5 mg in the evening. Persistent hiccups and labile blood pressure resolved after increasing the dose to 20 mg in the morning and 10 mg in the evening. A review of prior records revealed similar presentations of intractable hiccups during his initial diagnosis of adrenal insufficiency, further supporting their association. During follow-up, reduced hydrocortisone dosing led to a recurrence of hiccups during an acute illness, which he promptly recognized as under replacement, leading to timely dose adjustment. Discussion: Intractable hiccups are associated with diaphragm dysfunction, medullary abnormalities, and gastrointestinal disorders. While rare, their link to adrenal insufficiency may be mediated by cortisol deficiency disrupting autonomic or neuromodulatory pathways, compounded by hyponatremia-related neuromuscular instability. This case highlights the importance of considering adrenal insufficiency in patients with unexplained persistent hiccups, particularly when accompanied by systemic symptoms or hyponatremia. Moreover, hiccups may be a clinical marker of insufficient steroid replacement, underscoring the need for vigilant dose titration during acute illness or physiological stress. Conclusion: This case underscores intractable hiccups as a rare but clinically significant symptom of adrenal insufficiency. Recognizing this association can facilitate timely diagnosis and treatment, improving outcomes for affected patients. Presentation: Monday, July 14, 2025