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Hyperkalemia
17%
20/120
Hyperpigmentation
Salt wasting
12%
14/120
Elevated plasma cortisol level
15%
18/120
Hypoglycemia
39%
47/120
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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.
3.4
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