A 28-year-old woman with autoimmune thyroiditis presents with progressive fatigue, dizziness, and orthostatic hypotension. Vital signs show BP 92/58 mmHg, HR 102 bpm, RR 18, temperature 37.2°C, SpO2 98% on room air. She denies recent medication changes. Laboratory evaluation reveals 8 AM cortisol 2.8 μg/dL (normal >10), ACTH 185 pg/mL (normal <46), sodium 128 mEq/L, and potassium 5.8 mEq/L. Abdominal imaging is unremarkable. Which of the following is the most likely diagnosis?
- A)Panhypopituitarism
- B)Primary hypothyroidism
- C)Secondary adrenal insufficiency
- D)SIADH
- E)Primary adrenal insufficiency (Addison disease)GABARITO
Explicação
This patient has primary adrenal insufficiency (Addison disease), likely autoimmune given the thyroid history. Low cortisol with elevated ACTH (>100) is pathognomonic for primary adrenal failure. Hyponatremia and hyperkalemia reflect loss of aldosterone and co... Ver explicação completa e trilha adaptativa →