Adrenal Disorders USMLE Step 1 Practice Question
A 38-year-old previously healthy man presents to the emergency department with acute onset severe abdominal pain, nausea, and altered mental status. His wife reports he has been increasingly fatigued over the past month with progressive darkening of his skin. Physical examination reveals marked hyperpigmentation of his lips and buccal mucosa. Vital signs are: BP 78/48 mmHg, HR 122/min, RR 24/min, temperature 38.2°C. Laboratory studies show: sodium 118 mEq/L, potassium 6.8 mEq/L, glucose 54 mg/dL, cortisol 1.8 μg/dL (8 AM), ACTH 680 pg/mL. Abdominal imaging is unremarkable. Which of the following is the most appropriate initial management?
Answer choices
- AAdminister intravenous hydrocortisone 100 mg immediately, followed by 50-100 mg every 6-8 hours, and initiate aggressive normal saline infusionCorrect answer
- BAdminister intravenous dexamethasone 4 mg stat, then 2 mg every 6 hours pending ACTH stimulation test results
- CBegin slow hypotonic fluid replacement and sodium restriction to avoid osmotic demyelination syndrome
- DPerform emergent abdominal CT with contrast and surgical consultation for suspected mesenteric ischemia
- EInitiate empiric broad-spectrum antibiotics and obtain blood cultures before administering any steroids
- FAdminister intravenous dextrose alone while awaiting results of a 60-minute ACTH stimulation test
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