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 … .