A 45-year-old woman with a history of chronic fatigue noticed hyperpigmentation of her skin. Laboratory findings included low serum concentrations of sodium and cortisol and elevated concentrations of potassium and adrenocorticotropic hormone (ACTH)
A short-term ACTH test (the synanthem stimulation test) was performed and an elevation of serum cortisol level was noticed, far below the expected normal response. There was no evidence of lung or breast cancer. The most likely cause of this disease is
A. autoimmune adrenalitis
B. amyloidosis
C. tuberculosis
D. metastatic carcinoma destroying both adrenals
E. Waterhouse-Friderichsen syndrome
A
This patient has adrenal insufficiency (Addison's disease). Autoimmune adrenalitis is today the most common cause of adrenal insufficiency, whereas other causes such as amyloidosis and tuberculosis are rare. Addison's disease may result from bilateral metastases of lung or breast carcinoma, but this patient had no evidence of malignancy. Waterhouse-Friderichsen disease is characterized by acute adrenal insufficiency that results from intra-adrenal hemorrhage following meningococcal septicemia.
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