NBME 6 - doubt

[DrNarcissistic]

Hi everyone,

I recently took NBME 6 for step 2 ck prep and have a doubt. I'll be happy if someone can help with the explanation to the answer

26yo F in ED with marked confusion for 2 hours; flu-like illness for 3 days. Over the past 6 weeks, Increased fatigue, weakness, and nausea. Recently started thyroid hormone replacement therapy for autoimmune thyroiditis; 1 week ago, her serum thyroid-stimulating hormone concentration was 3 uUmL. T 38C, BP 80/40, P 140/min. Appears confused and lethargic, with cool, mottled skin. Generalized hyperpigmentation, especially involving the palmar creases. Lungs clear. Labs show: Hb 10, WBC 9k (segmented PMNs 55%, eosinophils 20%, lymphocytes 25%); serum Na 124, Cl 92, K 6.4 HCO3 16. CXR and u/a normal. ECG shows sinus tachycardia with peaked T waves. Which to confirm cause?
Answer is: ACTH stimulation test

Options were:

• Measurement of artery pressure
• Measurement of right atrial pressure
• Measurement of serum anti thyroglobulin antibody concentration
• Measurement of serum LDH activity
• Measurement of serum TSH
• ACTH stimulation test
• Dexamethasone supression test
• Blood culture
• Echocardiography

Thanks in advance!

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[Dr. Opout]

Hi everyone,

I recently took NBME 6 for step 2 ck prep and have a doubt. I'll be happy if someone can help with the explanation to the answer

26yo F in ED with marked confusion for 2 hours; flu-like illness for 3 days. Over the past 6 weeks, Increased fatigue, weakness, and nausea. Recently started thyroid hormone replacement therapy for autoimmune thyroiditis; 1 week ago, her serum thyroid-stimulating hormone concentration was 3 uUmL. T 38C, BP 80/40, P 140/min. Appears confused and lethargic, with cool, mottled skin. Generalized hyperpigmentation, especially involving the palmar creases. Lungs clear. Labs show: Hb 10, WBC 9k (segmented PMNs 55%, eosinophils 20%, lymphocytes 25%); serum Na 124, Cl 92, K 6.4 HCO3 16. CXR and u/a normal. ECG shows sinus tachycardia with peaked T waves. Which to confirm cause?
Answer is: ACTH stimulation test

Options were:

• Measurement of artery pressure
• Measurement of right atrial pressure
• Measurement of serum anti thyroglobulin antibody concentration
• Measurement of serum LDH activity
• Measurement of serum TSH
• ACTH stimulation test
• Dexamethasone supression test
• Blood culture
• Echocardiography

Thanks in advance!

My thought process was hypotension + pigmentation + hyponatremia + hyperkalemia = Addison's disease

What part did you doubt?