A 42-year-old woman has primary hypothyroidism and on levothyroxine replacement. She has malaise, nausea, and abdominal pain for 5 months. Her blood pressure is 88/60 mmHg, and HR is 98/minute. Her labs show Random Glucose 80 mg/dL (70-100 mg/dl) Creatinine 1.0 mg/dL (0.5-1.2mg/dl) Sodium 135 meq/L (135-145 meq/L) Potassium 5.0 meq/L (3.5-5 meq/L) TSH 4 mU/L (0.5-5.0 mu/L) Which of the following is the best test to investigate her symptoms?
سؤال مجاني 1 من 10 اليوم · اشترك وكمّل بدون حد
اعرض الإجابة
الإجابة والشرح
ادخل لحسابك عشان نحفظ إجاباتك ونوريك أخطاءك.
الإجابة: B. monitoring serum ACTH and cortisol
Months of malaise, nausea, abdominal pain and hypotension with upper-normal K⁺ in a woman with autoimmune hypothyroidism suggests adrenal insufficiency (likely autoimmune, polyglandular). The best initial test is morning serum cortisol with ACTH (low cortisol confirms; high ACTH = primary, low ACTH = secondary).
- 24-h urinary free cortisol (C) and late-night salivary cortisol (D) are screening tests for Cushing's (excess), not deficiency.
- TSH is normal on levothyroxine, so free T4 (A) adds nothing; pituitary MRI (E) only comes after a low ACTH is shown.
ليش كل خيار صح أو غلط
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A
ليش غلط
On levothyroxine the thing monitored is TSH with the clinical state; her TSH of 4 is normal, so a free T4 is not the test her symptoms call for.
✓ Step Up To Medicine 6th Edition 2024 (Thyroid).pdf · p. 9 -
B
ليش صح
Cortisol is the initial test (low in adrenal insufficiency) and ACTH then tells the cause: low in secondary AI, high in Addison disease (primary).
✓ RT - Adrenal.pdf · p. 12 -
C
ليش غلط
24-hour urinary cortisol is one of the screening tests for Cushing syndrome (cortisol excess), not a test for adrenal insufficiency.
✓ 6• Cushing's Syndrome & Disease [Notes].pdf · p. 5 -
D
ليش غلط
Late-night salivary cortisol is one of the screening tests for Cushing syndrome (cortisol excess), not a test for adrenal insufficiency.
✓ 6• Cushing's Syndrome & Disease [Notes].pdf · p. 5 -
E
ليش غلط
Head MRI is done only after ACTH shows secondary AI, to look for pituitary destruction or compression; it is not the first test.
✓ Adrenal disorders (2).pdf · p. 5
- المصدر
- Adrenal disorders (2).pdf · p. 5
RT - Adrenal.pdf · p. 12 - المحاضرة
- Adrenal Insufficiency · Endocrinology · Module B
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