UWorld question pituitary failure mistake???

[medInUSA]

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35 yo dude complains of weakness and fatigue of one day duration. He's anorexic and lost all interest in activities. He also complains of cold intolerance and constipation. His BP is 98/72 , temp is 37.1 C , Resp are 14/min, and pulse is 50. His skin is dry and rough, nails are brittle and hair is thin. There is NO hyperpigmentation of the skin. Delayed deep tendon reflexes are noted on Neuro exam.

Labs: anemia, Na: 135, potassium:4.0

which of the following is the most consistent with this patient's physical findings?

a) autoimmune destruction of adrenals
b) adrenal tb
c) adrenal CMV infxn
d) pituitary tumor

answer D



IN the explanation they lean on the Absence of hyperpigmentation and the normal potassium level.

HOWEVER:

the mineralocorticoids (which mainly maintain BP) are not controlled by the ACTH cortisol axis. So the patient should not have hypotension (only mild orthostatic hypotension from the lack of cortisol).

mistake???😱😕😡🙁😱😕
!!!!!!!!!😱

 

[Rendar5]

35 yo dude complains of weakness and fatigue of one day duration. He's anorexic and lost all interest in activities. He also complains of cold intolerance and constipation. His BP is 98/72 , temp is 37.1 C , Resp are 14/min, and pulse is 50. His skin is dry and rough, nails are brittle and hair is thin. There is NO hyperpigmentation of the skin. Delayed deep tendon reflexes are noted on Neuro exam.

Labs: anemia, Na: 135, potassium:4.0

which of the following is the most consistent with this patient's physical findings?

a) autoimmune destruction of adrenals
b) adrenal tb
c) adrenal CMV infxn
d) pituitary tumor

answer D



IN the explanation they lean on the Absence of hyperpigmentation and the normal potassium level.

HOWEVER:

the mineralocorticoids (which mainly maintain BP) are not controlled by the ACTH cortisol axis. So the patient should not have hypotension (only mild orthostatic hypotension from the lack of cortisol).

mistake???😱😕😡🙁😱😕
!!!!!!!!!😱

adrenal insufficiency also can cause hypotension. I've seen cases where fluids and pressors are not enough to raise the bp fo someone with acute adrenal insufficiency and hydrocortisone is required to resuscitate.

 

[temmie]

adrenal insufficiency also can cause hypotension. I've seen cases where fluids and pressors are not enough to raise the bp fo someone with acute adrenal insufficiency and hydrocortisone is required to resuscitate.

I think the case can also be explained hypothyroidism secondary to pituitary failure because that could also explain the symptoms without giving you hyperpigmentation.

T

 

[butaloh666]

....

 

[Scaredshizzles]

adrenal insufficiency also can cause hypotension. I've seen cases where fluids and pressors are not enough to raise the bp fo someone with acute adrenal insufficiency and hydrocortisone is required to resuscitate.

Well primary adrenal insufficiency certainly can cause hypotension and labile BP...Along with hypoglycemia, hyperkalemia/hyponatremia, etc. But I think it is a valid question to what extent second adrenal insufficiency from a process wiping out ACTH production would cause hypotension given that aldosterone release is largely controlled through renin-angiotension pathway. But certainly hypocortisolism itself to some extent can cause hypotension, hard to quantify it though. But 98/72 is not that low of a BP, so I think it is a reasonable question.