A reversible severe gait disorder

A 53-year-old man was admitted for a 6-month progressive disabling gait disorder, weight loss, and increasing fatigue. Examination revealed a markedly impaired gait and flexion contractures of hips and knees, with limited extension (video 1 at [Neurology.org][1]). EMG and whole neuraxis MRI were normal. Laboratory workup proved primary adrenal insufficiency (AI) (serum cortisol 2.4 μg/dL, ACTH 513.8 pg/mL). Flexion contractures of the lower limbs1,2 (FCLL) due to AI was suspected. Prompt treatment with hydrocortisone supplementation led to a substantial clinical improvement (video 2). FCLL is a well-known but infrequent sign of AI. Prompt identification and treatment may reverse this disorder. [1]: http://neurology.org/lookup/doi/10.1212/WNL.0000000000003190