Introduction: A 36-year-old lady presented obtunded to another hospital. She had bilateral pleural effusions and ascites and underwent laparotomy. She was known to have premature ovarian failure of eight years duration. No pathology was demonstrated at operation and post operatively she required ventilation and ionotropic support. Subsequent investigation demonstrated hypothyroidism and hypoadrenalism as the cause of illness.

Follow up: She was transferred to our institution for further investigation when she developed a seizure disorder in association with ongoing weakness necessitating ventilation. Extra-pontine myelinolysis was demonstrated on MRI of the brain. She had not been hyponatraemic.

Conclusions: The association between hypoadrenalism and the acute neurological disturbance will be discussed.

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