Addison's disease, lab values

[bbaggins]

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If someone can see the error in my thinking and help me out that would be awesome.

My understanding of Addison's disease:

Typical presentation includes fatigue, anorexia, weight loss, nausea and vomiting, skin hyperpigmentation especially at skin creases, hypotension.

Typical lab values: increased ACTH, decreased cortisol, decreased aldosterone, decreased sodium, increased potassium.

Assuming the above is not correct, is it possible to have the same presentation, same ACTH and cortisol levels, but normal aldosterone sodium and potassium? How about increased ACTH, normal cortisol, increased aldosterone, increased sodium and decreased potassium. Or any other set of lab values different that what I've listed. Thanks for the help.

 

[oceanillusion42]

If someone can see the error in my thinking and help me out that would be awesome.

My understanding of Addison's disease:

Typical presentation includes fatigue, anorexia, weight loss, nausea and vomiting, skin hyperpigmentation especially at skin creases, hypotension.

Typical lab values: increased ACTH, decreased cortisol, decreased aldosterone, decreased sodium, increased potassium.

Assuming the above is not correct, is it possible to have the same presentation, same ACTH and cortisol levels, but normal aldosterone sodium and potassium? How about increased ACTH, normal cortisol, increased aldosterone, increased sodium and decreased potassium. Or any other set of lab values different that what I've listed. Thanks for the help.

To my knowledge anything other than the lab values you outlined above would be impossible, as the very nature of Addison's is a general, overall adrenal insufficiency (i.e. all 3 cortical divisions). Varying amounts of aldosterone and sex hormones are seen in CAH, thus also effecting K+ concentration, but as far as Addison's I think that what you see is what you get.

 

[Jamiu22]

If someone can see the error in my thinking and help me out that would be awesome.

My understanding of Addison's disease:

Typical presentation includes fatigue, anorexia, weight loss, nausea and vomiting, skin hyperpigmentation especially at skin creases, hypotension.

Typical lab values: increased ACTH, decreased cortisol, decreased aldosterone, decreased sodium, increased potassium.

Assuming the above is not correct, is it possible to have the same presentation, same ACTH and cortisol levels, but normal aldosterone sodium and potassium? How about increased ACTH, normal cortisol, increased aldosterone, increased sodium and decreased potassium. Or any other set of lab values different that what I've listed. Thanks for the help.

It is possible, but highly unlikely - it would have to be multiple diseases interposed in one.... such as Mild Addison's plus Conn's syndrome (the one bolded above)... but highly, highly highly unlikely

Anything's possible in real life - but not typical of step questions... they try to trim down your assumptions to stuff on uworld.