-18 years-old, female

-16 months ago, she complained of acute right iliac pain with vomiting, no motion changes: presented to some E.R. and was given NSAID injection and dexamethasone injections

-The following month the same pain recurred: same NSAID injection and dexamethasone injections!

-With continuity of the same pain, she was diagnosed to have appendicitis and underwent appendectomy

-During the 2 months post-surgery she had epigastric pain, vomiting and diarrhea: received P.P.I., antibiotics and dexamethasone injections!

-Then she developed left hypochondrial pain, diagnosed to have renal colic, C.T.-urinary tract revealed no stones: received antibiotics and dexamethasone injections!

-After which, she had a leg wound with sutures done: also received antibiotics and dexamethasone injection!

-Then she had a fracture with casting: also received dexamethasone injection!

-She was told that much of these complications are results of dexamethasone injection, so she stopped this, nearly-continuous, dexamethasone injections

-4 days following dexamethasone stoppage she had: dizziness, palpitations, hypoglycemia (R.B.S. 25 mg/dl)

-Despite she received glucose infusions, hypoglycemia persisted

-She had C-peptide done: mildly elevated

-So, E.U.S. recommended and done: no abnormalities detected

-Now presented to us with:

-Dyspnea, tachycardia (180 bpm)

-persistent hypoglycemia attacks

-Generalized weakness

 

-On examination:

-very anxious patient

-So, after attending this patient I deduce these results:

-This severe anxiety caused psychosomatic manifestations resulting in much of the above symptoms, with that trail of dexamethasone injections and surgeries, and obviously adrenal hypofunction manifestations when dexamethasone stopped abruptly

-This generalized weakness resulted from hypokalemia induced by these frequent panic attacks resulting from respiratory alkalosis (in contrast to the usual respiratory alkalosis-induced hypocalcemia), which is a rare presentation!