A 34-year-old woman with autoimmune Addison disease on hydrocortisone and fludrocortisone presents with acute severe abdominal pain, confusion, and hypotension (BP 88/52, HR 118). Temperature is 38.2°C, respiratory rate 22/min. Serum sodium is 125 mEq/L, cortisol 58 μg/dL. She denies recent medication changes or missed doses. Which of the following best explains her acute decompensation?
- A)Adrenal crisis from sudden discontinuation of replacement therapy
- B)Development of secondary adrenal insufficiency from pituitary disease
- C)Inadequate glucocorticoid and mineralocorticoid dosing during acute stressGABARITO
- D)Acute thyroid crisis precipitating adrenal insufficiency
- E)Excessive glucocorticoid replacement causing iatrogenic Cushing syndrome
Explicação
This patient is experiencing an adrenal crisis from inadequate hormone replacement during acute illness (likely infection given abdominal pain). The low sodium indicates insufficient mineralocorticoid coverage, and the clinical picture of hypotension and menta... Ver explicação completa e trilha adaptativa →