Addison Disease

A 38-year-old woman presents to the emergency department with a 3-month history of progressive fatigue, weight loss of 8 kg, and recurrent episodes of syncope. On examination, she is hypotensive (BP 88/54 mmHg), has generalized hyperpigmentation over the knuckles, elbows, and buccal mucosa, and appears chronically ill. Laboratory investigations reveal: sodium 128 mEq/L, potassium 5.8 mEq/L, fasting glucose 62 mg/dL, and elevated ACTH 850 pg/mL with cortisol 2.2 µg/dL (8 AM). A chest X-ray shows bilateral hilar lymphadenopathy. What is the most likely diagnosis?

A 52-year-old man with a known history of pulmonary tuberculosis (treated 2 years ago) presents to the outpatient clinic with a 6-week history of progressive weakness, anorexia, and recurrent episodes of dizziness. His wife reports that he has become increasingly withdrawn and forgetful. On examination, he is found to be hypotensive (BP 92/58 mmHg) and has darkening of the skin over the palms and creases. Serum sodium is 132 mEq/L and potassium is 5.2 mEq/L. A morning cortisol level is 3.5 µg/dL (normal > 10 µg/dL) and ACTH is 620 pg/mL. Which of the following is the most appropriate next step in management?

A 52-year-old man with a known diagnosis of Addison disease (on stable replacement with prednisolone 5 mg daily and fludrocortisone 0.1 mg daily) presents to the emergency department with acute-onset severe abdominal pain, vomiting, and diarrhea following a 2-day history of upper respiratory tract infection. His blood pressure is 100/65 mmHg (baseline 115/75 mmHg), heart rate 110/min, and he appears acutely unwell. Serum sodium is 132 mEq/L and potassium is 5.2 mEq/L. What is the most appropriate immediate management?

A 38-year-old man from rural India presents with a 6-month history of progressive fatigue, weight loss, and hyperpigmentation. Investigations reveal low cortisol, elevated ACTH, and hyponatremia. CT abdomen shows bilateral adrenal enlargement with calcification. What is the most common cause of his primary adrenal insufficiency?

A 38-year-old woman presents with progressive fatigue, weight loss, and hyperpigmentation. Investigations reveal serum sodium 128 mEq/L, potassium 5.8 mEq/L, and a morning cortisol of 3 µg/dL. ACTH is markedly elevated at 450 pg/mL. A diagnosis of primary adrenal insufficiency (Addison disease) is confirmed. What is the drug of choice for glucocorticoid replacement in this patient?