Adrenal insufficiency Quiz: Ace Your Exams

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A 47-year-old female comes to her primary care physician with chronic fatigue, abdominal pain, and sleep disturbance. Past medical history is notable for hypothyroidism, for which she takes levothyroxine. Vital signs are within normal limits, and physical examination is notable for mucosal hyperpigmentation. Laboratory testing is notable for hyponatremia, hyperkalemia, and a TSH that is within normal limits. Which of the following hormonal parameters are most reflective of this patient’s clinical presentation?

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Corticotropin release hormone (CRH)	Adrenocorticotropic hormone (ACTH)	Aldosterone	Cortisol
↓	↓	normal	↑

Corticotropin release hormone (CRH)	Adrenocorticotropic hormone (ACTH)	Aldosterone	Cortisol
↑	↓	normal	↓

Corticotropin release hormone (CRH)	Adrenocorticotropic hormone (ACTH)	Aldosterone	Cortisol
↑	↑	normal	↑

Corticotropin release hormone (CRH)	Adrenocorticotropic hormone (ACTH)	Aldosterone	Cortisol
↓	↓	normal	↓

Corticotropin release hormone (CRH)	Adrenocorticotropic hormone (ACTH)	Aldosterone	Cortisol
↑	↑	↓	↓