Question 10#
A 56-year-old man with a past medical history of hypertension, hyperlipidemia, and type II diabetes mellitus presents to his primary care physician for a follow-up visit. He started working as a welder 6 months ago and was recently diagnosed with hypersensitivity pneumonitis after complaining of worsening shortness of breath at the time. He was prescribed a medication whose name he is unable to recall but stopped taking them abruptly after 2 months because of his busy schedule. His other medications include amlodipine, atorvastatin, and hydrochlorothiazide though he admits being noncompliant with those, too.
Today, he reports fatigue, unintentional weight loss of 7 lbs in 2 weeks, nausea, and lightheadedness.
Pertinent vital signs include a temperature of 37.6°C, blood pressure of 117/58 mm Hg, pulse rate of 92 beats/min, and respiratory rate of 12 breaths/min.
What are the MOST likely laboratory findings in this patient?
B. B
C. C
D. D
E. E
Correct Answer is B
Comment:
Correct Answer: B
Sudden withdrawal of prolonged steroid therapy can lead to low adrenocorticotropic hormone (ACTH) levels due to suppression of the hypothalamic-pituitary-adrenal axis, leading to mineralocorticoid and glucocorticoid deficiency. The patient likely developed adrenal insufficiency after abrupt cessation of his prednisone that he was prescribed for treatment for hypersensitivity pneumonitis. The symptoms vary based on the severity of adrenal insufficiency; however, they most commonly manifest with fatigue, weight loss, and GI symptoms, such as nausea and vomiting. Mineralocorticoid deficiency results in excessive sodium loss and insufficient potassium excretion in the urine. Significant laboratory findings include hyponatremia, hyperkalemia, and anemia which are all due to the mineralocorticoid and glucocorticoid deficiency due to suppressed hypothalamic-pituitary dysfunction.
Reference:
- Broersen LHA, Pereira AM, Jørgensen JO, Dekkers OM. Adrenal insufficiency in corticosteroids use: systematic review and metaanalysis. J Clin Endocrinol Metab. 2015;100(6):2171-2180.