Case 5 Endocrinology Part 2 Answers

Endocrinology Case 5

Expanded Case Evaluation
Expert's Answers

A. Expanded Database - Diagnostic Test Results

1 Test / Procedure: ECG: See slide 1
Results:

Bradycardia and enlarged T waves are present

Review indications & protocol in notes.

What is your assessment?
Findings consistent with hyperkalemia

2 Test / Procedure: ACTH Stimulation Test
Results:

Pre-Cortisol: <10 nmol/L (28-110), Post Cortisol: 15 nmol/L (172-464)

Review indications & protocol in notes.

What is your assessment?
Primary hypoadrenocorticism (Addison's disease) is present.

B. Final Diagnosis

Primary hypoadrenocorticism

C. Therapeutic Plan

0.9% NaCl IV. SoluCortef IV. Monitor urine output. Repeat corticosteroids every 2-4 hours until diuresis is established. Administer fludrocortisone or desoxycorticosterone pivilate for mineralocorticoid effects. Use desoxycorticosterone for maintenance (less expensive). Supplement diet with NaCl and give glucocorticoids in low diseases to stimulate appetite (if needed).

To view other manifestations of hypoadrenocorticism, click on the image at right.

Endocrinology Case 5

Expanded Case Evaluation Expert's Answers

Expanded Case Evaluation
Expert's Answers