A 57 year old man with rheumatoid arthritis abruptly stops taking long term prednisone because of worsening edema. Two days later he develops weakness, nausea, and dizziness. Blood pressure is 90 over 55 mm Hg. Laboratory studies show low cortisol, low ACTH, normal potassium, and no hyperpigmentation. Which of the following best explains this presentation?
- A)Autoimmune destruction of the adrenal cortex
- B)Suppression of hypothalamic CRH and pituitary ACTH from chronic glucocorticoid therapyGABARITO
- C)Bilateral adrenal hemorrhage
- D)Aldosterone synthase deficiency
- E)Pheochromocytoma after beta blocker therapy
Explicação
Chronic exogenous glucocorticoids suppress CRH and ACTH, causing secondary adrenal insufficiency if the medication is stopped abruptly. Aldosterone production is largely preserved because it is regulated mainly by the renin angiotensin system, so hyperkalemia ... Ver explicação completa e trilha adaptativa →