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Welcome to your 12

What are the arrows (i.e.,⬆️ , ⬇️, or ↔️) for?

  • 45M + one-year Hx of fatigue and darkening of skin of forearms + BP 100/60; exogenous ACTH is administered and shows marginal increase in Cortisol levels. Prior to administration of ACTH, what are the arrows (i.e.,⬆️ , ⬇️, or ↔️) for this patient’s serum ACTH, Eosinophils, Na ⁺ , K ⁺ , pH, Bicarbonate, and CO₂?
  • This patient has Addison disease.
  • The ACTH stimulation test is used to diagnose, which will show a very marginal increase in serum cortisol, thereby demonstrating the patient has adrenal insufficiency (i.e., unable to adequately make Cortisol in response to ACTH).
  • Healthy patients will demonstrate a robust increase in serum cortisol in response to exogenous ACTH.
  • Patients with Addison have low serum cortisol and aldosterone. Low cortisol means less negative feedback at the hypothalamus and anterior pituitary, leading to increased CRH and ACTH levels.
  • Eosinophilia is a common finding in Addison disease. This is especially prevalent in 2CK-level IM Qs. Once again, do not go chasing stool ova and parasites.
  • Low aldosterone means less sodium reabsorption, as well as less potassium and proton secretion in the cortical collecting duct of the distal kidney. Retention of protons means serum bicarb is low.
  • CO2 is low because the patient will have metabolic acidosis, so it is blown off as compensation.