BOF 16
A 39-year-old Asian male is admitted with a history of
vomiting and abdominal pain. The patient has been unwell and anorexic for some
time prior to admission. On examination the patient looks unwell, is febrile,
tachycardic and hypotensive. The skin is pigmented and lacks turgor and the eyes
look sunken. The buccal mucosa, and skin creases are pigmented. The abdomen
feels rigid.
Investigations reveal an elevated blood urea with low serum
sodium and high serum potassium. There is hypercalcaemia and hypoglycaemia.
The feature that will help to differentiate primary
glandular failure form secondary glandular failure is:
a)
Hyperkalaemia
b)
Elevated eosinophil count
c)
Anaemia
d)
Fever
e)
Hypoglycaemia
Answer:
a)
The patient has adrenal insufficiency. The features of
mineralocorticoid deficiency (sodium and water depletion, hyperkalaemia and
hypercalcaemia) are usually due to primary adrenal failure and are absent or
less marked in secondary adrenal failure.
Last Updated: 19/02/06
