C.K. is a 48 yo white woman who presents to her primary care provider with loss of appetite, progressive fatigue, and mild nausea for the past five days. C.K. and her husband are visiting he

Case Study 1
C.K. is a 48 yo white woman who presents to her primary care provider with loss of appetite, progressive fatigue, and mild nausea for the past five days. C.K. and her husband are visiting her sister in Wyoming for two weeks, but she has not felt well enough to bicycle, hike, or climb for the past week. Her sister has insisted that she see a healthcare professional. CK presents the following signs/symptoms:

Swelling of face
Bright red rash that covered her torso and face, reportedly with fever
Prominent tanning of the skin, although she denies significant exposure to the sun
Salt cravings before nausea developed
Weight loss of 6 pounds in the last month
Abdominal CT scan revealed moderate bilateral atrophy of the adrenal glands

PATIENT A LABORATORY TEST RESULTS
Na 126 meq/L (135-145 mEq/L)
K 5.2 meq/L (3.7 to 5.2 mEq/L)
TSH 3.2 ?U/mL (0.4 and 4.0 ?U/mL)
Cortisol 2.0 ?g/dL (5 to 25 ug/dL)
ACTH 947 pg/mL (9 to 52 pg/mL)
Vitamin B12 700 pg/mL ( 160 to 950 pg/mL)
Rapid ACTH Stimulation Test

1. Identify all signs and symptoms in this patient that are consistent with Addison disease.

2. Would supplementation with fludrocortisone be appropriate in this patient?

3. What is the significance of ACTH stimulation test?

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