Auricular-cartilage calcification in longstanding adrenal insufficiency

Q: 36 years old patient is admitted to ICU with syncope, hypotension, and hypoglycemia. Patient is a known case of chronic adrenal insufficiency.  Medical student documented in his physical exam an absence of auricular-cartilage calcification. In patients with chronic adrenal insufficiency, auricular-cartilage calcification occurs exclusively in? (select one)

A) male

B) female

Answer: A

For reasons not fully understood, auricular-cartilage calcification in longstanding primary or secondary adrenal insufficiency occurs exclusively in men. This unusual sign was first reported almost seven decades ago.

Although the cause is known as chronic cortisol deficiency, this natural gender bias is hard to explain. Moreover, it does not reverse or improve with glucocorticoid replacement.

#endocrinology

References:

1. Barkan A, Glantz I. Calcification of auricular cartilages in patients with hypopituitarism. J Clin Endocrinol Metab 1982; 55:354.

2. Calvo Catalá J, Hortelano Martínez E, González-Cruz Cervellera MI, et al. [Calcification of auricular cartilages in a patient with adrenal insufficiency: presentation of a case and review of the literature]. An Med Interna 1994; 11:496.

3. JARVIS JL, JENKINS D, SOSMAN MC, THORN GW. Roentgenologic observations in Addison's disease; a review of 120 cases. Radiology 1954; 62:16.