Uworld question on Addison's disease

[medInUSA]

35 yo dude has weakness fatigue, wt loss, over the past year. He's anorexic and lost all interest in activities. BP is 98/70, temp is 37.1, resp is 14, pulse is 74
he is irritable and restless. There is hyperpigmentation on the skin
he's got
Hb 10.3
WBC 3000
Na 130
Potassium 5.5
CXR and PPD are normal
what is the next best step in the management of this patient???


a) cosyntropin stimulation test
b) Begin hydrocotisone

their answer is cosyntropin!!!

WTF!!!!

the dude is hemodynamically unstable, he's got low BP
why in the world would you do a confirmatory test, first before starting to treat him for the addison's its obvious from the presentation he's got the disease????

what do you guys think?

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[AFDuck]

Did the UW explanation mention anything about their definition of hemodynamic instability? Usually they're pretty good about ruling out the wrong answers for you.

 

[Scaredshizzles]

35 yo dude has weakness fatigue, wt loss, over the past year. He's anorexic and lost all interest in activities. BP is 98/70, temp is 37.1, resp is 14, pulse is 74
he is irritable and restless. There is hyperpigmentation on the skin
he's got
Hb 10.3
WBC 3000
Na 130
Potassium 5.5
CXR and PPD are normal
what is the next best step in the management of this patient???


a) cosyntropin stimulation test
b) Begin hydrocotisone

their answer is cosyntropin!!!

WTF!!!!

the dude is hemodynamically unstable, he's got low BP
why in the world would you do a confirmatory test, first before starting to treat him for the addison's its obvious from the presentation he's got the disease????

what do you guys think?

He's not in crisis, he doesn't need immediate treatment....There are a lot of causes for secondary adrenal insufficiency, including metastatic cancer and infections including HIV. In the former case it wouldn't hurt to start steroids, but an infection like HIV or even Tb----probably not the best idea unless the patient is severely debilitated by the insufficiency.

 

[ComicBookHero20]

He's not in crisis, he doesn't need immediate treatment....There are a lot of causes for secondary adrenal insufficiency, including metastatic cancer and infections including HIV. In the former case it wouldn't hurt to start steroids, but an infection like HIV or even Tb----probably not the best idea unless the patient is severely debilitated by the insufficiency.

but he has primary adrenal insufficiency -- he has hyperpigmented skin

 

[medInUSA]

He's not in crisis, he doesn't need immediate treatment....There are a lot of causes for secondary adrenal insufficiency, including metastatic cancer and infections including HIV. In the former case it wouldn't hurt to start steroids, but an infection like HIV or even Tb----probably not the best idea unless the patient is severely debilitated by the insufficiency.

But the Cosyntropin stimulation test will NOT tell you if the adrenal failure is from HIV/TB/Virus/Autoimmune. All it will confirm is that there is primary adrenal failure. ANd then you will start the corticosteroids followed by fludrocortisone.

 

[medInUSA]

but he has primary adrenal insufficiency -- he has hyperpigmented skin

yes you are right this is primary adrenal failure. What Scaredschizzled meant is that the Primary Adrenal Failure can be caused by various infectious or autoimmune processes.

 

[souljah1]

the question is stupid. you could easily do both. give him dexamethasone and stim him if you want to confirm your physical exam findings.

 

[AFDuck]

I agree that this isn't a very well written question, I don't remember seeing questions this muddy on the real thing so don't sweat it too much.