|
 | Presentation
 | Guy from San Franscisco, HIV + |
| Someone who got the "flu" and never
bounced back |
|
| History
| Previous illnesses, fatigue, diarrhea, cramps |
| Depression, dizziness, anorexia, weight loss, nausea |
| Irritiblility, restlessness, psychosis |
| Dizzy when stand, skin pigmentation increased, difficulty
recovering from stress |
|
| PE
| Vitals: hypotensive, tachycardic, do orthostatics |
| HEENT: pigmentation of oral
mucosa |
| CV: do a regular exam |
| Lungs: auscultate |
| Skin: hyperpigmentation |
| Neuro: mental status check |
|
| DDx
| Hypothyroidism |
|
| Laboratory
| CBC w/ diff, BMP, UA, stat glucose, |
| TSH, 24-hour urine cortisol, 8 am cortisol, ACTH level |
| ACTH stimulation test (normal minimal respose is to go
greater than 20) |
| EKG, CXR |
|
| Treatment
| Admit to telemetry |
| IV fluids: make sure you have dextrose in your fluids |
| Steroid replacement: hydrocortisone, fludrocortisone
|
|
| Miscellanous
| Most common causes of adrenal insufficiency
 | Addison's |
| CMV, TB, other fungal infections, Kaposi's,
cryptococcus |
| Sarcoidosis, bilateral adrenal hemorrhage with
Waterhouse-Friedrichsen syndrome (dissemminated gonococcus) |
|
|
|
