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  #1  
Old 01-07-2011
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Arrow NBME form 7 Q#204

A 52-year-old woman has had slowly progressive weakness and weight loss of 9 kg (20 lb) for 4 months. She has never traveled outside of the USA. Her blood pressure is 82/50 mm Hg. Her skin shows diffuse hyperpigmentation. Plasma concentration of ACTH is markedly increased, and the serum concentration of cortisol is decreased. CT scans of the chest and abdomen disclose no mass lesions. Which of the following is the most likely etiology of this patient's disease?

A) Autoimmune

B) Congenital

C) Infectious

D) Metabolic

E) Neoplastic

plz give me the reasons for your answer. Thankz
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  #2  
Old 01-07-2011
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man ur really pumpin em out arn't ya..

its addisons dx which therefore, autoimmune.. il post reason in a few minutes.. at least it looks like it 2 me, i didn;t really focus on the vignette very closely, kinda busy lol

ok while i still have time, it seems that her adrenals have failed so thts 1 clue...

2nd clue is that shes a women hahah, they more commonly have autoimmune dx's

and ummmm, the increase ACTH would explain why she had diffuse hyperpigmentation also

so addisons, unless im totally dumb and not seeing something here
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Old 01-07-2011
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You are absolutely correct. Very good explanation. Thanks for your effort and time.
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  #4  
Old 01-08-2011
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actually, the U/s shows no masses, so we could also exclude neoplastic compression of the adrenals which could have been a possibility.
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