A 28-year-old woman on long-term prednisone for systemic lupus erythematosus presents with progressive fatigue, weakness, and orthostatic hypotension during glucocorticoid taper. Vital signs show BP 92/58 mmHg, HR 102 bpm, RR 16/min, temperature 36.8°C. Laboratory studies reveal cortisol 8 μg/dL and ACTH <2 pg/mL. Morning glucose is normal. Which of the following best explains this clinical presentation?
- A)Primary adrenal insufficiency from lupus-related destruction
- B)Pituitary adenoma developing as a complication of lupus
- C)Secondary adrenal insufficiency from chronic glucocorticoid suppression of the HPA axisGABARITO
- D)Acute adrenal crisis from tuberculosis complicating immunosuppression
- E)ACTH-independent Cushing syndrome from long-term steroid therapy
Explicação
Chronic glucocorticoid therapy suppresses ACTH via negative feedback on the hypothalamic-pituitary axis, causing secondary (central) adrenal insufficiency. Upon abrupt taper or discontinuation, the adrenal glands (which atrophied from lack of ACTH stimulation)... Ver explicação completa e trilha adaptativa →