Which combination of findings most strongly suggests primary adrenal insufficiency (Addison disease)?

Which combination of findings most strongly suggests primary adrenal insufficiency (Addison disease)?

• A. Hypotension with hyponatremia, hyperkalemia, and hyperpigmentation.
• B. Hypertension with hypernatremia and edema.
• C. Normal blood pressure with normal electrolytes.
• D. Hyperglycemia with polyuria and weight loss.

Answer: (A)

Primary adrenal insufficiency occurs when the adrenal cortex cannot produce enough cortisol and aldosterone. Without aldosterone, the kidneys waste sodium and retain potassium, leading to hyponatremia and hyperkalemia with resulting volume depletion and hypotension. Cortisol deficiency compounds the problem by reducing vascular responsiveness and contributing to fatigue and weakness. The increased ACTH that results from loss of cortisol feedback also causes hyperpigmentation of skin and mucous membranes. This combination of low sodium, high potassium, low blood pressure, and hyperpigmentation is the classic presentation of Addison disease. The other scenarios fit conditions with either high blood pressure or normal electrolytes, or with hyperglycemia from diabetes, none of which match the adrenal crisis pattern.

Primary adrenal insufficiency occurs when the adrenal cortex cannot produce enough cortisol and aldosterone. Without aldosterone, the kidneys waste sodium and retain potassium, leading to hyponatremia and hyperkalemia with resulting volume depletion and hypotension. Cortisol deficiency compounds the problem by reducing vascular responsiveness and contributing to fatigue and weakness. The increased ACTH that results from loss of cortisol feedback also causes hyperpigmentation of skin and mucous membranes. This combination of low sodium, high potassium, low blood pressure, and hyperpigmentation is the classic presentation of Addison disease. The other scenarios fit conditions with either high blood pressure or normal electrolytes, or with hyperglycemia from diabetes, none of which match the adrenal crisis pattern.