Adrenal Disorders USMLE Step 1 Practice Question
A 70-year-old man with metastatic lung adenocarcinoma presents with progressive fatigue, anorexia, and weight loss. Vital signs show BP 92/58 mmHg, HR 104 bpm, RR 16, temperature 37°C. He reports orthostatic dizziness but denies fever. Examination reveals diffuse hyperpigmentation. Labs show sodium 128 mEq/L, potassium 5.8 mEq/L, morning cortisol 3 μg/dL. CT demonstrates bilateral adrenal enlargement. Which diagnosis best explains these findings?
Answer choices
- AAutonomous aldosterone production
- BSuppression of ACTH by exogenous steroids
- CIsolated destruction of the adrenal medulla
- DDestruction of the adrenal cortex by metastatic diseaseCorrect answer
- EPituitary stalk compression
- FPituitary metastases causing secondary adrenal insufficiency
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