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Review Question - QID 104331

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QID 104331 (Type "104331" in App Search)
A 16-year-old girl presents with fatigue and reports missing her period for the past several months though her prior menses were regular. She is short for her age. Her mother has been worried since her daughter started bumping into the furniture around the house. You perform a visual field in the office which reveals the following (Figure A). Vital signs are stable with the exception of blood pressure which is slightly lower than her baseline. The remainder of her physical examination is unremarkable. Regarding this patient, one would also expect to find:
  • A

Hyperkalemia

17%

20/120

Hyperpigmentation

17%

20/120

Salt wasting

12%

14/120

Elevated plasma cortisol level

15%

18/120

Hypoglycemia

39%

47/120

  • A

Select Answer to see Preferred Response

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Secondary adrenal insufficiency is usually caused by a pituitary mass. This patient has clinical signs of multiple hormone deficiencies and the classic clinical finding of a bitemporal hemianopsia. Deficiency in growth hormone due to panhypopituitarism may result in hypoglycemia.

Remember that adrenal insufficiency can be divided into primary, secondary, and tertiary causes. Primary adrenal insufficiency is also known as Addison's disease and is most often idiopathic or autoiummune but may also be due to infectious disease (i.e. tuberculosis), iatrogenic causes, or metastatic cancer. Secondary adrenal insufficiency is most often seen in patients with decreased pituitary ACTH production. Tertiary adrenal insufficiency occurs when patients with chronic exogenous steroid use abruptly withdraw from their intake of steroids.

Figure A depicts the classic visual field defect of bitemporal hemianopsia indicating a chiasmal mass.

Incorrect Answers:
Answers 1-3: Hyperkalemia, hyperpigmentation, and salt wasting occur in primary adrenal insufficiency but not in secondary adrenal insufficiency.
Answer 4: Plasma cortisol level would be depressed, not elevated, in secondary adrenal insufficiency.

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