A 35-year-old woman presents with progressive fatigue, weakness, and diffuse skin hyperpigmentation. Vital signs show hypotension (90/55 mmHg), heart rate 102 bpm, and temperature 37.2°C. Laboratory studies reveal hyponatremia (128 mEq/L), hyperkalemia (5.8 mEq/L), elevated morning plasma ACTH (150 pg/mL), and low morning cortisol (3 μg/dL). She denies recent illness or fever. She takes no medications. Which of the following is the most likely diagnosis?
- A)Cushing syndrome
- B)Primary adrenal insufficiency (Addison disease)GABARITO
- C)Secondary adrenal insufficiency from pituitary adenoma
- D)Hyperaldosteronism with secondary hypokalemia
- E)Acute adrenal crisis from sepsis
Explicação
Primary adrenal insufficiency presents with low cortisol, elevated ACTH (loss of negative feedback), hyperpigmentation (ACTH stimulates melanocytes), and characteristic electrolyte abnormalities (hyponatremia from aldosterone deficiency and loss of free water ... Ver explicação completa e trilha adaptativa →