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Addison's disease — SCE Endocrinology MCQ

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EasyAdrenalAddison's diseaseSCE Endocrinology

A 32-year-old woman has fatigue, weight loss and dizziness. She is hyperpigmented, blood pressure is 92/58 mmHg and sodium is 126 mmol/L with potassium 5.8 mmol/L. Short Synacthen test shows cortisol 110 nmol/L at baseline and 130 nmol/L at 30 minutes. What is the most likely diagnosis?

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Correct answer: B — Primary adrenal insufficiency

Hyperpigmentation, hyponatraemia, hyperkalaemia and a flat Synacthen response indicate primary adrenal failure with mineralocorticoid deficiency. Secondary adrenal insufficiency usually lacks hyperkalaemia and hyperpigmentation. The pearl is that aldosterone loss is the clue to primary disease.

Reference: Society for Endocrinology adrenal crisis guidance, Endocrine Society adrenal insufficiency guideline