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 … .
CHIEF COMPLAINT:

INTERVAL UPDATES


Does the pt have any autoimmune disorders?

PMH


S U B J E C T I V E

HPI
Is there significant weight loss?
- The presence of significant weight loss would suggest Addison’s disease, pellagra, hyperthyroidism, or an ectopic hormone–secreting tumor.
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: Is there hyperpigmentation?
- The presence of hyperpigmentation suggests Addison’s disease.
hyperpigmentation. Temporal and vertex hair loss.
Chest: No Gynecomastia.

LABS
No new labs.

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 .
- BUN of …
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 .
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 .

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 17-hydroxysteroids & 17-ketosteroids.
(+/-) Antiadrenal antibodies
(+/-) CT scan of abdomen
(+/-) Metyrapone test
—- f/u in … .

Result - Copy and paste this output:

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