aaroho
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A 50-year old woman is admitted for UTI,complicated by profound weakness,abd.pain, vomiting and diarrhea.Her temp. is 40C, BP-90/60 PS-110, RR-18/min Examination reveals signs of dehydration and skin hyperpigmentation over the elbows and knees.Urin analysis shows pyuria.Lab studies show hyponatremia, hyperkalemia and hypoglycemia.CBC is remarkable for eosinophilia. While waiting for the results of urine and blood culture, broad-spectrum antibiotic and volume replacement therapy is instituted.In addition to such Rx, which of the following is the most appropriate next step?
A-Cortisol level
B-Cosyntropin stimulation test
C-IV mineralocorticoids
D-Oral corticosteroids
E-Renal ultrasonography
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| kpmle2
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A-Cortisol level
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| donjuan
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B she has addisons
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| Kamsi
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B( Addison or Adrenal Insufficiency)
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| doyoudig
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Adrenal Insuff -- Cortisol levels -- Hypotensive, hyponatremia, hyperkalemia and hypoglycemia
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| elitoki
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A
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| Ivonne
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B Cosyntropin stimulation test (ACTH analog). This patient seems to have Addison Disease and that test is a rapid screening test. I was thinking also about a rapid treatment with hydrocortisone in very sick patient like the one given but since the alternative is oral glucocorticoid and the patient has been vomiting it is not a good idea... . Could you explain the answer aaroho
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| dr in trouble
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B
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| aaroho
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Answer is A-cortisol level
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| Ivonne
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complete explanation PZ
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| Ivonne
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So, next step in patients with suspected Addison disease is:
CORTISOL level (very insensitive test) less than 3mg/Dl is diagnostic of Addison if indeterminate further work-up
Next step: Evaluate hypothamic-pituitary axis by cosyntropin stimulation test. Is that right?
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| chemamr
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good question
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| Ivonne
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UW Q#0041:
Best screening test for suspected primary adrenal insufficiency(not necessary next step): cosyntropin a value of cortisol >20mcg/Dl rules out Addison
Then Next step ACTH level to distinguish between 1ry and 2ry adrenocortical deficiency if >than 50pg/ml is primary if more than 50 secondary.
Does someone know the work up for Addison? help
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| RitaM
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It is definitely the cosyntropin test.But wouldnt you prime the patient with steroids and fluids before that.The basic workup for Addisons is serum electrolytes ,morning cortisol and then cosyntropin test.
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| RitaM
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Oh,yah I forgot we have to do an abdominal CT too.
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