Tertiary adrenal insufficiency in a patient with familial Mediterranean fever: Association or coincidence?

A 16-year-old boy was referred to our hospital due to recurrent fever with chest and abdominal pain.The patient had developed monthly febrile attacks lasting a few days beginning at 10 years of age, but these attacks increased in frequency to twice a month three years later.Familial Mediterranean fever (FMF) was diagnosed based on the clinical symptoms and identification of the MEFV genotype carrying a pathogenic mutation in exon 10 (M694I) and a nonconfirmatory mutation in exon 2 (E148Q).Although oral colchicine 1 mg/day decreased the severity of fever, chest pain, and abdominal pain and improved levels of acute-phase proteins, recurrent febrile attacks persisted, and the patient presented with nonepisodic headache and malaise (Figure 1).Colchicine 1.5 mg/day suppressed the elevated levels of C-reactive protein and serum amyloid A, but headache and malaise did not improve.Considering the previous reports describing the case of hypoadrenal syndrome with FMF, hypoadrenocorticism was suspected due to nonepisodic symptoms. 1,2While loss of appetite, nausea, arthralgia, weight loss, hyperpigmentation, loss of axillary or pubic