Primary Adrenal Insufficiency (Addison Disease): The Daily PANCE Blueprint

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Primary Adrenal Insufficiency (Addison Disease): The Daily PANCE Blueprint

A 38-year-old woman presents with several months of fatigue, weight loss, nausea, and lightheadedness on standing. On exam she has hyperpigmentation of the palmar creases and buccal mucosa, and her blood pressure is 92/58 mm Hg. Laboratory studies show sodium 128 mEq/L, potassium 5.6 mEq/L, and a low morning cortisol. Which of the following is the most likely diagnosis?

A. Secondary adrenal insufficiency
B. Syndrome of inappropriate antidiuretic hormone (SIADH)
C. Cushing syndrome
D. Primary adrenal insufficiency (Addison disease)
E. Primary hypothyroidism

Answer and topic summary

The answer is D. Primary adrenal insufficiency (Addison disease).

Fatigue, weight loss, orthostatic hypotension, hyponatremia with HYPERkalemia, and especially HYPERPIGMENTATION are classic for primary adrenal insufficiency. In primary disease the adrenal cortex fails, so ACTH rises (and its precursor drives melanocytes → hyperpigmentation) and aldosterone is lost (→ low sodium, high potassium). Secondary adrenal insufficiency (pituitary ACTH deficiency) causes low ACTH, so there is NO hyperpigmentation and potassium is usually normal. SIADH gives hyponatremia but not hyperkalemia or hyperpigmentation; Cushing syndrome is cortisol EXCESS; and hypothyroidism does not cause this electrolyte pattern.

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Endocrinology ⇒ Diseases of the Adrenal Glands ⇒ Corticoadrenal Insufficiency

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