A 70-year-old man with metastatic lung adenocarcinoma presents with progressive fatigue, anorexia, and weight loss. Vital signs show BP 92/58 mmHg, HR 104 bpm, RR 16, temperature 37°C. He reports orthostatic dizziness but denies fever. Examination reveals diffuse hyperpigmentation. Labs show sodium 128 mEq/L, potassium 5.8 mEq/L, morning cortisol 3 μg/dL. CT demonstrates bilateral adrenal enlargement. Which diagnosis best explains these findings?

  1. A)Autonomous aldosterone production
  2. B)Suppression of ACTH by exogenous steroids
  3. C)Isolated destruction of the adrenal medulla
  4. D)Destruction of the adrenal cortex by metastatic diseaseGABARITO
  5. E)Pituitary stalk compression

Explicação

Bilateral adrenal metastases can destroy enough adrenal cortex to produce primary adrenal insufficiency. The hyperpigmentation, hyperkalemia, and low cortisol indicate primary rather than secondary adrenal failure. Cancer is therefore acting through cortical d... Ver explicação completa e trilha adaptativa →

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