Adrenal insufficiency Quiz: Ace Your Exams
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A 56-year-old woman is brought to the emergency department by her husband due to altered mental status. The husband reports the patient has been experiencing significant fatigue, myalgias, and abdominal pain for the past 2 days. The patient returned from a trip to Mexico two days ago. Before she left Mexico, she had four days of diarrhea and chills which continued upon returning home. Past medical history is significant for Hashimoto thyroiditis for which she takes levothyroxine. Temperature is 37°C (98.6°F), blood pressure is 90/55 mm Hg, pulse is 114/min, respirations are 22/min, and oxygen saturation is 95% on room air. On physical examination, the patient appears lethargic with dry mucous membranes. There is evidence of mucosal hyperpigmentation. Laboratory studies are obtained and shown below. Which of the following is the most appropriate management for this patient?
| Laboratory value | Result |
| Hemoglobin | 14.2 g/dL |
| Leukocyte count | 8,100 /mm3 |
| Platelet count | 260,000/mm3 |
| Neutrophils | 55% |
| Eosinophils | 13% |
| Basophils | 0% |
| Lymphocytes | 25% |
| Monocytes | 7% |
| Sodium | 124 mEq/L |
| Potassium | 5.8 mEq/L |
| Chloride | 101 mEq/L |
| Bicarbonate | 18 mEq/L |
| Glucose | 50 mg/dL |
| CRP | 15 mg/L |
| TSH | 1.8 mIU/L |
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