MDLB 297 Clinical Chemistry Case Study # 10( A 30-year-old white female presente
ID: 3516157 • Letter: M
Question
MDLB 297 Clinical Chemistry Case Study # 10( A 30-year-old white female presented to h 20-pound and er physician with a chief complaint of fatigue, anorexia, and a weight loss over the last 6 months. The patient also complained of frequent nausea, vomiting, occasional dizzy spells. Physical examination revealed a thin, pale female with a blood pressure of 60. I ncreased pigmentation was noted in the axilla, palms of the hands, and areolae. pigmented patches also were noted in the oral mucosa 90/ Laboratory evaluation revealed a serum level of 135 mEq/L, potassium level of 5.7 mEq/L, bicarbonate level of 20 mEq/L, glucose level o 60 mg/di (3.3 mmol/L, and BUN of 40 mg/di (14.3 mmol/L), Hematologic evaluation showed a mild normocytic anemia with a white blood count of 8200 (55% lymphocytes, 10% eosinophils, 8% monocytes, 27% neutrophils) Questions: 1. What is the differential diagnosis of this patient's condition, and what diagnosis is most likely 2. What laboratory tests would you use to confirm the diagnosis? 3. What is the most likely etiology?Explanation / Answer
Differential diagnosis:
1. Addison disease ( Adrenocortical insufficiency)
2. Adrenal crisis
3. Adrenal hemorrhage
4. C-17 Hydroxylase deficiency
5. Histoplasmosis
6. Tuberculosis
7. Sarcoidosis
Laboratory test confirming the diagnosis: ACTH stimulation test- cortisol level fail to rise after synthetic ACTH stimulation due to destruction of adrenal cortex.
Most likely etiology:
Idiopathic autoimmune (80%)
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