Adrenal Pathology

Question 1

patient presents with chronic fatigue, weight loss, GI sxs, hyponatremia, and hyperkalemia associated with a low-normal cortisol level. This is a typical presentation of ___.

Answer 1

primary adrenal insufficiency
(Addison disease)

–Aldosterone deficiency causes volume depletion, which can manifest as hyperkalemia, hypotension or syncope
–hyponatremia s/t salt wasting, volume depletion, and increased ADH release.
–Skin signs can include hyperpigmentation or vitiligo

Question 2

The initial evaluation for primary adrenal insufficiency (Addison’s disease) should include (2)

Answer 2

8 AM serum cortisol
Plasma ACTH levels

ACTH stimulation test confirms diagnosis

Question 3

low/low-normal cortisol level (<5 µg/dL)
+
high ACTH

confirms what diagnosis

Answer 3

primary adrenal insufficiency
(Addison’s disease)

(High-normal/High cortisol rules out dx)

Question 4

low cortisol level
+
low ACTH

suggests what diagnosis?

Answer 4

central adrenal insufficiency
⬩ Secondary (pituitary)
⬩ Tertiary (hypothalamus)

Question 5

ACTH stimulation test (cosyntropin test) can confirm the diagnosis of Adrenal Insufficiency.

Infusion of Cosyntropin normally triggers a rapid ___ in serum cortisol.

Answer 5

increase in cortisol

(no significant increase in cortisol after test confirms adrenal insufficiency)

Cosyntropin = synthetic ACTH analog