A 33-year-old woman presents with progressive fatigue, nausea, 8-kg weight loss, and orthostatic dizziness. Vital signs show BP 98/62 mmHg, HR 102 bpm, RR 18/min, temp 36.8°C, SpO2 98%. Morning serum cortisol is 3 mcg/dL (normal >10). After cosyntropin stimulation test, cortisol rises only to 5 mcg/dL. ACTH level is elevated at 88 pg/mL. No recent medication use reported. Which diagnosis best explains these findings?
- A)Pheochromocytoma
- B)SIADH due to malignancy
- C)Central diabetes insipidus
- D)Primary adrenal insufficiency with impaired adrenal responseGABARITO
- E)Normal adrenal reserve
Explicação
Cosyntropin is synthetic ACTH used to assess adrenal cortical reserve. Minimal cortisol rise after stimulation suggests primary adrenal insufficiency because the adrenal cortex cannot respond appropriately. In early secondary adrenal insufficiency the adrenals... Ver explicação completa e trilha adaptativa →