Which clinical manifestation indicates to the nurse that the client's adrenocortical insuffi-ciency is of primary origin rather than secondary origin?
A. Weight loss
B. Red, beefy tongue
C. Orthostatic hypotension
D. Increased skin pigmentation
D
With primary adrenocortical insufficiency, the adrenal gland is not able to produce sufficient amounts of adrenocortical hormones. The low circulating levels of these hormones stimulates the hypothalamus to release corticotropic-releasing hormone (CRH), which in turn causes the anterior pituitary to release large amounts of ACTH and melanocyte-stimulating hormone (MSH). The increased MSH causes increased skin pigmentation. Because secondary adrenocortical in-sufficiency does not stimulate higher endocrine centers, MSH levels are not increased, and there is no increase in skin pigmentation.
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