Question

J.S. is a 58-year-old female brought to the emergency department (ED) at 7:00 AM by her husband because when she got up this morning she was light-headed, confused, and so weak that she could not dress herself. J.S.’s husband immediately drove her to the ED in her pajamas. She has a history of rheumatoid arthritis and had been taking prednisone (Deltasone) 10 mg daily. Subjective Data Husband states that J.S. hasn’t been feeling good, has been tired, and has had very little appetite Husband states he lost his job a couple of months ago and J.S. stopped taking her medication a couple of weeks ago because they could not afford it because they no longer had health insurance J.S. denies a headache or blurred vision Objective Data Physical Examination Temperature 98.7° F, pulse 94, respirations 20, blood pressure 100/60 No difficulty speaking Oriented to name only Poor skin turgor Dry mucous membranes Weakness in bilateral upper and lower extremities Diagnostic Studies Lab values Glucose 68 mg/dL Calcium 9.2 mg/dL Sodium 130.0 mEq/L Potassium 5.5 mEq/L HCO3 25.4 mEq/L Chloride 93.5 mEq/L Cortisol 4 mcg/dL (normal 8:00 am level is 5-23 mcg/dL) Discussion Questions Interpret J.S.’s laboratory results and describe their significance. What other assessment findings could confirm a diagnosis of adrenal insufficiency? What is the likely cause of J.S.’s adrenal insufficiency and why? Would J.S.’s adrenal insufficiency be considered to be from a primary cause (Addison’s disease) or a secondary cause? Why?

Answer 1

Adrenal insufficiency

It is a conditin in whic the adrenal glands do not produce adequate amount of cortisol and impaired production of aldosterone which regulate the sodium conservation, pottassium secreation and water retention.

1.What are the other laboratory findings could confirm a diagnosis of adrenal insuffiecy?

1. ACTH STIMULATION TEST
2. INSULIN TOLERANCE TEST
3. CRH STIMULATION TEST

ACTH STIMULATION TEST

In this test injecting man made IV ACTH, if a little or no increase in cortisol level indicates adrenal insuffiency.

INSULIN TOLERANCE TEST

In this an IV injection of insulin is made,if the glucose level drops too low leads to trigger the pitutory to make more ACTH.If cortisol level is too low indicates pitutory is ot making enough cortisol.

CRH STIMULATION TEST

The patient is being injected with IV CRH. If the pitutory is damaged it won't make ACTH in responce to the CRH injection which indicates secondary adrenal insufficiency.A slow rise in ACTH indicates tertiary adrenal insufficiency.

2. What are the likely cause of J.S's adrenal insufficency and why?

The normal amount of the cortisol level is 5-23mcg/dl and J.S have only 4mcg/dl. It can be due to the sudden stoppage of taking Prednisone because the sudden cause of adrenal insufiency may happen when the person is suddently stopping corticosteroid after taking along time.

3. Would J.S 's adrenal insufficiency be considered to be from a primary cause (Addison's disease) or secondary cause? why?

J.S's adrenal insuffiency is considered to be from secondary cause because secondary cause of adrenal insufficiency is due to decreased production of cortisol which results from the sudden withdrawl from taking the corticosteroids. But secondary causes are the problem with pitutory gland, pea size bulged base of the brain, shrinked adrenal gland and lack of ACTH.