A 26-year-old women comes to the offfice due to worsening fatigue and weight loss. She has a history of primary hypothyroidism and she takes levothyroxine. Physical examination is normal. Blood pressure is 115/75 mmHg supine and 92/61 mmHg on standing. Laboratory results are as follows: Which of the following changes in circulating hormone levels are expected in this patient?

Question

A 26-year-old women comes to the offfice due to worsening fatigue and weight loss. She has a history of primary hypothyroidism and she takes levothyroxine. Physical examination is normal. Blood pressure is 115/75 mmHg supine and 92/61 mmHg on standing. Laboratory results are as follows:  Which of the following changes in circulating hormone levels are expected in this patient?

Quizplus · Accepted Answer

Eductional Objective: Primary adrenal insufficiency usually involves autoimmune destruction of the bilateral adrenal cortex.  Reduced aldosterone production leads to renal salt wasting with hypovolemia, hypotension, and hyperkalemia.  The hypovolemia and reduced cortisol-induced inhibition of antidiuretic hormone lead to water retention and hyponatremia.  Reduced cortisol also causes decreased circulating epinephrine with a compensatory increase in norepinephrine.

A 26-Year-Old Women Comes to the Offfice Due to Worsening