Adrenal Insufficiency (Addison)
CHIEF COMPLAINT: [text name name="variable_7" default=""] INTERVAL UPDATES [textarea ="variable_7" default=""] [comment memo="Does the pt have any autoimmune disorders?"] PMH [textarea="variable_6" default=""] S U B J E C T I V E HPI [comment memo="Is there significant weight loss? - The presence of significant weight loss would suggest Addison’s disease, pellagra, hyperthyroidism, or an ectopic hormone–secreting tumor."][text box name="variable_1" default="No"] weight loss. No history of TB exposure or positive PPD test. ROS Denies darkening of the skin, fatigue and weakness; hair loss. O B J E C T I V E VITALS BP Pulse Weight: BMI: Height Waist CirL’ PHYSICAL EXAM Skin: [comment memo="Is there hyperpigmentation? - The presence of hyperpigmentation suggests Addison’s disease."] [text box name="variable_2" default="No"] hyperpigmentation. Temporal and vertex hair loss. Chest: No Gynecomastia. LABS No new labs. [comment memo="What is the plasma cortisol? - LOW plasma cortisol suggests ADDISONS is the cause. - ADRENOGENITAL syndrome and CHRONIC RENAL DISEASE may be associated with a defect in aldosterone synthesis causing the same picture."] - Plasma cortisol of [text box name="variable_3" default=""]. - BUN of … [comment memo="What is the chloride level? - An increased chloride points to diabetic acidosis, Addison’s disease, renal tubular acidosis, nephritis, and use of certain diuretics as the cause. "] - Urine chloride of [text box name="variable_4" default=""]. [comment memo="What is the sodium level? - A low plasma cortisol coupled with a low sodium and elevated chloride suggests Addison’s disease."] - Plasma sodium level of [text box name="variable_5" default=""]. HbA1c: SMBG FREQUENCY C-Peptide Fructosamine Hgb/Hct TSH/T4 Total Cholesterol HDL LDL Triglycerides Serum Creatinine Creatinine Clearance Microalbumin Eye Exam Foot Exam Flu Vaccine Smoking H Cessation MEDICATIONS Diabetes Meds (Oral) 1 2 3 Diabetes Meds (Insulin) 1 2 3 Lipid Lowering Meds 1 2 3 Blood Pressure Meds 1 2 3 Other Meds 1 2 3 Allergies Recent Hospitalizationbs: IMAGING No new imaging. A S S E S S M E N T - No lab abnormalities. - No anorexia, hypotensive episodes, I M P R E S S I O N # POSSIBLE ADRENAL INSUFFICIENCY - A serum cortisol and ACTH stimulation test will identify Addison’s disease as a decreased plasma cortisol would help to confirm my suspicion of Addison’s disease. - Low BP likely 2/2 salt wasting and hypovolemia. P L A N • Pre-corticotrophin serum cortisol • ACTH stimulation test • Post-corticotrophin serum cortisol • 24-hour urine collection [comment memo="17-hydroxysteroids & 17-ketosteroids. "] (+/-) Antiadrenal antibodies (+/-) CT scan of abdomen (+/-) Metyrapone test —- f/u in … .
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