keepgoing
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A 42-year-old Caucasian woman with no history of prior surgery complains of extreme weakness and fatigability that has persisted for the past 5 months. She reports nausea and stomach cramps and has had trouble keeping solid foods down. She is hypotensive while sitting, and her blood pressure falls even more upon standing. She notes increased freckling around her eyes, and on examination, her palmar creases appear darkened. Serum potassium is 6.5 mEq/L. Which of the following is the most likely diagnosis?
A. Addison's disease
B. Conn's syndrome
C. Cushing's syndrome
D. Nelson's syndrome
E. Secondary adrenal insufficiency
F. Tertiary adrenal insufficiency
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| tompat
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got to be A.
CUZ IN CONN'S -- hypertention
cushing's same no hypotention
no nelson--- no surgery , adrenalectomy-bilateral
no secondary or tertiary cuz then there wont be any ACTH and no hyperpigmentation.
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| keepgoing
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tompat wrote:
got to be A.
CUZ IN CONN'S -- hypertention
cushing's same no hypotention
no nelson--- no surgery , adrenalectomy-bilateral
no secondary or tertiary cuz then there wont be any ACTH and no hyperpigmentation.
tompat,will give ans when all will reply but juz one question here u mentioned in sec/tert adrenal insufficency-->NO ACTH-->NO HYPERPIGMENTATION,thn in ur question "close call"how come with simillar condition there is high pigmentation??sorry if im wrong juz want to clear this concept..
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| tompat
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hi there,me too wanted to discuss that but cudn't send any messages.
in secondary or tertiary adrenal insufficiency there is no acth---so no hyperpigmentation.
in my q there is destruction of adrenal gland, so its a sorta primary adrenal insufficiency, where cortisol can't be produced to keep ACTH down.
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| new_n_lost
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E. Secondary adrenal insufficiency this is my answer
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| new_n_lost
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tompat wrote:
got to be A.
CUZ IN CONN'S -- hypertention
cushing's same no hypotention
no nelson--- no surgery , adrenalectomy-bilateral
no secondary or tertiary cuz then there wont be any ACTH and no hyperpigmentation.
Explain Her Dysphagia ???
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| tompat
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nausea , vomitting stomach cramps,
i think i screwed up.
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| new_n_lost
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Now Think of it in this way Lung Ca NSCC or SCC compression of the Esophagus Alongwith Adrenal Insufficiency. hopefully this is the Answer cos I really dont Know anything abt Tertiary Adrenal Insufficiency.
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| tompat
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thats what i thought, small cell ca,just 1 min back
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| tompat
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in tertiary, hypothalamus screws up
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| tompat
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if it were to be small cell there wont be any hypotention
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| tompat
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god are the mets pressing on IVC,
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| new_n_lost
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tompat wrote:god are the mets pressing on IVC,
Dude it Depends on the Position of the Ca whether in the Posterior Medinastinum or Anterior
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| new_n_lost
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Somebody is Sharp on their Endo 
Ur Answer is right Tompat Why r u Worrying ??
I m Just Messing with U 
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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| keepgoing
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tompat wrote:
in secondary or tertiary adrenal insufficiency there is no acth---so no hyperpigmentation.
in my q there is destruction of adrenal gland, so its a sorta primary adrenal insufficiency, where cortisol can't be produced to keep ACTH down.
so i agree with ur this statement...but in ur question low/or almost none cortisol giving msg to pituat to semd more ACTH i hope i m rt..if not really need to review and now going to do so..will post answer to my question in evening!!!thanks tompat
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| tompat
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jumanji
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| keepgoing
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answer is A 
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| keepgoing
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tompat wrote:nausea , vomitting stomach cramps, i think i screwed up.
got confused here??DYSPHAGIA--->nausea-->b/c of which patient might be feeling difficult in getting solid food propel down not any physical barrier or obstruction(ca compression)...
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