Ursula Nnaobi presents to the emergency room with a 2-month history of weight loss, nausea and weakness. She appears very thin (55 kg), chronically ill, with a blood pressure of 90/70, heart rate 102 lying, and you can’t detect her blood pressure when she stands up. She is diffusely hyperpigmented, with hypopigmented patches.
What diagnosis do you suspect?
Adrenal insufficiency.
How will you make the diagnosis?
Baseline ACTH level.
Cortrosyn stimulation test:
- Administer 250 ug of ACTH iv or im
- Check serum cortisol at baseline and one hour later (normal stimulated cortisol will be >500 nmol/L)
- Treat with normal saline, dexamethasone simultaneously if patient is unstable (plus DDAVP if hyponatremic so hyponatremia does not resolve too quickly)
Write a prescription for what medication(s) she will go home on.
Cortef 10 mg q AM, 5 mg q PM po
Florinef 0.1 mg daily po
