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Primary adrenal crisis — ABIM Board MCQ

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ModerateEndocrinology/MetabolismPrimary adrenal crisisABIM Board

A 36-year-old woman with autoimmune thyroid disease presents with vomiting, abdominal pain, hyperpigmentation, and hypotension. Sodium is 122 mEq/L, potassium is 6.0 mEq/L, glucose is 48 mg/dL, and cortisol drawn before treatment is pending. Which of the following is the most likely cause?

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Correct answer: E — Autoimmune adrenal cortical destruction causing primary adrenal insufficiency

Hyperpigmentation, hypotension, hyponatremia, hyperkalemia, hypoglycemia, and autoimmune history suggest primary adrenal insufficiency from autoimmune adrenalitis, presenting as adrenal crisis.

Reference: Endocrine Society Primary Adrenal Insufficiency Guideline