Author: Brenna Ori, DO
Senior Editor: Heather Rainey, MD
Editor: Jesse Miller, MD
Patient Presentation:
A 19-year-old male triathlete presented to the medical tent at the USA Triathlon following the
<br>completion of an Olympic distance event reporting profound fatigue. The patient stated he felt
<br>well during the whole race, but at the finish line noticed a sudden overwhelming sense of
<br>weakness that felt different than normal post-race fatigue. Other associated symptoms included
<br>mild abdominal pain and some muscle tightness.
History:
The patient reported similar incidents of these
<br>symptoms during past races though admitted that his current symptoms are much milder than they
<br>have been previously. He has required hospitalization for similar symptoms at prior events. His
<br>past medical history is significant for adrenoleukodystrophy status post bone marrow transplant 8
<br>years ago and primary adrenal insufficiency for which he is on hydrocortisone 25mg daily
<br>divided into three doses and fludrocortisone 0.1mg daily.
Physical Exam:
General: Awake, alert, and answering questions appropriately
<br>Skin: Diaphoretic consistent with recent physical exertion
<br>CV: Tachycardic, no murmurs
<br>Respiratory: Lungs clear to auscultation
<br>Abdominal: Soft and not tender to palpation
<br>MSK: Moving all four extremities against gravity, but was unable to stand without assistance due
<br>to weakness.
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