Histor y: A 63 year old woman presented with dizziness, and easy fatigability, n

Question

History: A 63 year old woman presented with dizziness, and easy fatigability, nausea with occasional vomiting and progressive weight loss over eight months prior to presentation. There were no headaches, blurred vision and neither loss of consciousness nor change in her bowel habit.

Physical examination: Pale, asthenic elderly lady with hirsutism (increased facial hair due to excess androgens). No features of malnutrition or hypovitaminosis. Vital signs include a pulse of 106 bpm (normal 100 bpm); blood pressure of 100/60 mmHg supine and 70/40 mmHg sitting (normal 120/80). She could not stand on account of severe postural dizziness (low orthostatic blood pressure).

Laboratory Investigations: Lab results revealed fasting blood sugar was 3.6 mmol/L (normal 5.6 mmol/L), elevated very long chain fatty acids in the blood, Na+ levels of 120 mmol/L (135 – 145 mmol/L), blood K+ levels 7.0 mmol/L (normal 3.6 mmol/L), and mild acidosis.

1.What is your likely diagnosis?

2.What are the symptoms that made you consider that diagnosis?

3.What physical findings supported the decision?

4.What laboratory results supported the decision?

Explanation / Answer

1) The patient is suffering from Addison's disease. It is caused due to deficiency of hormones secreted by the adrenal cortex.

2) The symptoms like fatigue, weight loss, dizziness and nausea with excessive vomitting without blurring of vision and loss of consciousness in a 63 year old female points to the possibility of deficiency of hormones of adrenal cortex.

3) Physical findings like high pulse rate, low blood pressure, hirsutism and severe postural dizziness supported the decision.

4) The laboratory tests that supported the decision are,

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