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Old 06-13-2012
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Question Bronze pigmentation of skin

Your colleague reveals that she has become increasingly depressed over the past 3 months. She describes fatigue, loss of energy and loss of appetite. However, she also notes having increasingly hair loss in her pubic regions and that she has stopped having normal menstrual periods. You notice that there is bronze pigmentation of her skin and suggest that she may be experiencing an endocrine disorder. Which lab analysis below would be supportive of your presumptive diagnosis?
  • A. Na down, K up, CL down, bicarbonate down
  • B. Na down, K up, CL up, Bicarbonate up
  • C. Na normal, K down, Cl up, Bicarbonate up
  • D. Na down, K down, CL up, Bicarbonate down
  • E. Na up, K up, CL down , Bicarbonate down
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Old 06-13-2012
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The answer is A.

She has 1ry Addison's.
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Old 06-13-2012
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wasnt sure about A or B? but now i understand it's A

It is addison, the pigamntation fits with elevated proACTH - > MSH (stimulate melanin) and ACTH, lack of aldosterone will result in decrease Na reabsorption and decrease K and H secretion.

The difference is that Bicarb and the Cl levels,
Patients with addison will develope metabolic acidosis, we may assume that the kidney will try to fix the disturbance by reabsorbing Bicarbonate , but actually lack of aldosterone will also decrease the reabsorption of hco3 in the proximal tubule as the Na/H+ is decreased without aldosterone.
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Old 06-13-2012
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It's A because the function of aldosterone is to reabsorb Na (and water) and secrete K and H. When a H is secreted, a HCO3 is reabsorbed (which represents new HCO3). If there's no aldosterone there won't be any new HCO3 reabsorbed and thus the metabolic acidosis.
Also Cl tends to follow Na therefore if Na goes down Cl tends to follow..
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Old 06-13-2012
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Default my answer

It's A) - signs of aldosterone depletion
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Old 06-13-2012
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its a..........addison disease
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