A 52-year-old woman presents with progressive weakness, fatigue, and darkening skin pigmentation despite minimal sun exposure. Vital signs reveal hypotension (88/52 mmHg), heart rate 102 bpm, and temperature 37.2°C. Laboratory studies show hyponatremia (Na+ 125 mEq/L), elevated ACTH (180 pg/mL; normal <50), and low morning cortisol (2 µg/dL). Thyroid function tests are normal. Which of the following is the most likely diagnosis?
- A)Acute adrenal hemorrhage from sepsis
- B)Cushing syndrome with secondary hyponatremia
- C)Tertiary adrenal insufficiency from hypothalamic dysfunction
- D)Primary adrenal insufficiency (Addison disease)GABARITO
- E)Secondary adrenal insufficiency from pituitary adenoma
Explicação
Primary adrenal insufficiency (Addison disease) presents with low cortisol, elevated ACTH (loss of negative feedback), hyponatremia, hypotension, and hyperpigmentation from elevated ACTH stimulating melanocytes. The elevated ACTH with low cortisol is the diagn... Ver explicação completa e trilha adaptativa →