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A 20 yr old woman has had progressive weakness, anorexia and intermittent vomiting and 6kg weight loss for past 6 months. She is thin, BP 80/60mm/Hg, and there is diffuse brown darkening of the elbow creases and in the old apendectomy scar. Which of the following laboratory findings is most likely in this patient?
1) ACTH inc or decr, or no change
2) serum cortisol incr or decre
3) aldosteron incr or decr
4) urin Na incr or decr
5) urin K incr or decr.

Please any explanation is apreciated.
I think if it is Addison disease as it looked ACTH will be increased cortisol not sure, should be decresed aldosteron decreased Na decreased in urine K increased in urine.
Here are the options:
A) ACTH decre cortisol decr aldo decre Na incre K decre
b) ACTH decre cort decre aldost normal Na normal K normal
c) ACTH incre cortisol decre aldost decre Na incre K decre
d) ACTH incre cortisol normal aldo incre Na incre K decre
e) ACTH incre cortisol incre aldo decre Na decre K incre

Please, any help!Thanks

MOD Edit :- hopefully the question will make more sense now. NNL

Edited by new_n_lost on Jun 01, 2008 - 5:11 PM. : Edited the format of the question


When you get elevated ACTH it also stimulates MSH= Melanocyte stimulating hormone, and from there you have n increase in pigmentation.

The gland suprarenal gland not working so you will have a low cortisol, the feedback will the high acth to make the gland work but the gland does not work therefor
increase acth and low cortisol


elevation of ACTH produce hyper pigmentation,associated mineralocorticoid deficiency lead to hyponatremia, hyperkalamia,dehydration hypotentiondecreased cardiac size,metabolic acidosis,wieght loss hypoglycemia.


OK, then elevated ACTH, hypoaldosteronism, but what will happen with Na in urine and K in urine. Would Na be incresed in urine and K decreased because Aldosteron has not been produced?


Thanks so much NNL I did not know how to interpet this Q in better way. Now you can edit it again and delete those 1-5 choices just live those under a,b,c... Thanks again.


c -
aldosteron - decr, hyperkalemia and hyponatremia, hence urin na incr, k decr
ACTH incr and cortisol decr.
Treatment options - corticosteroid + mineralocorticoid


Thanks everyone for help. Answer is C

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