Adrenal Disorders USMLE Step 1 Practice Question
A 34-year-old woman with autoimmune Addison disease on hydrocortisone and fludrocortisone presents with acute severe abdominal pain, confusion, and hypotension (BP 88/52, HR 118). Temperature is 38.2°C, respiratory rate 22/min. Serum sodium is 125 mEq/L, cortisol 58 μg/dL. She denies recent medication changes or missed doses. Which of the following best explains her acute decompensation?
Answer choices
- AAdrenal crisis from sudden discontinuation of replacement therapy
- BDevelopment of secondary adrenal insufficiency from pituitary disease
- CInadequate glucocorticoid and mineralocorticoid dosing during acute stressCorrect answer
- DAcute thyroid crisis precipitating adrenal insufficiency
- EExcessive glucocorticoid replacement causing iatrogenic Cushing syndrome
- FAutoimmune destruction of adrenal tissue progressing despite current replacement therapy
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