While this electrolyte combination may be more readily attributed to CAH, especially in the ED, it can occur in infants as a rare complication of UTI or urinary tract malformation due to renal tubular inflammation and dysfunction.3,4 In this case, the adrenal abscess likely exerted mass effect on renal collecting tubules, interfering with aldosterone receptor and electrolyte channel activity. This evidence concerns the gene NR3C2 and congenital adrenal hyperplasia.