BOF: 3.16
A 39-year-old Asian male is admitted with a history of
vomiting and abdominal pain. The patient has been unwell and anorexic for
some time prior to admission. On examination the patient looks unwell, is
febrile, tachycardic and hypotensive. The skin is pigmented and lacks turgor
and the eyes look sunken. The buccal mucosa, and skin creases are pigmented.
The abdomen feels rigid.
Investigations reveal an elevated blood urea with low
serum sodium and high serum potassium. There is hypercalcaemia and
hypoglycaemia.
The feature that will help to differentiate primary
glandular failure from secondary glandular failure is:
a)
Hyperkalaemia
b)
Elevated eosinophil count
c)
Anaemia
d)
Fever
e) Hypoglycaemia
Answer: a)
The patient has adrenal insufficiency. The features of
mineralocorticoid deficiency (sodium and water depletion, hyperkalaemia and
hypercalcaemia) are usually due to primary adrenal failure and are absent or
less marked in secondary adrenal failure
Revision Tip
Revise Addison's disease KEYS
to SUCCESS in Medicine 55-57
