Adrenal Disorders USMLE Step 1 Practice Question
A 28-year-old woman on long-term prednisone for systemic lupus erythematosus presents with progressive fatigue, weakness, and orthostatic hypotension during glucocorticoid taper. Vital signs show BP 92/58 mmHg, HR 102 bpm, RR 16/min, temperature 36.8°C. Laboratory studies reveal cortisol 8 μg/dL and ACTH <2 pg/mL. Morning glucose is normal. Which of the following best explains this clinical presentation?
Answer choices
- APrimary adrenal insufficiency from lupus-related destruction
- BPituitary adenoma developing as a complication of lupus
- CSecondary adrenal insufficiency from chronic glucocorticoid suppression of the HPA axisCorrect answer
- DAcute adrenal crisis from tuberculosis complicating immunosuppression
- EACTH-independent Cushing syndrome from long-term steroid therapy
- FThyroid storm from autoimmune thyroiditis exacerbated by glucocorticoid withdrawal
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