Patient:
- Name: Emily Turner
- Age: 42 years
- Gender: Female
- Occupation: Schoolteacher
- Chief Complaint: Persistent fatigue, weight loss, and dizziness over several months.
Presenting Symptoms:
- Emily reported a gradual onset of extreme fatigue, which significantly impacted her ability to perform daily activities and her work as a schoolteacher.
- She experienced unexplained weight loss of approximately 15 pounds over the past six months despite maintaining a regular diet.
- Emily also described frequent episodes of dizziness and lightheadedness, particularly when standing up from a seated or lying position.
Medical History:
- Emily had a history of asthma but was otherwise healthy before the onset of her symptoms.
- She denied any recent illnesses, surgeries, or significant stressors.
Physical Examination:
- Physical examination revealed Emily to be pale and fatigued.
- Her blood pressure was notably low, with readings averaging around 90/60 mm Hg.
- Emily appeared dehydrated, with dry mucous membranes.
- Laboratory tests revealed hyponatremia (low sodium levels) and hyperkalemia (high potassium levels) in her bloodwork.
- An electrolyte panel indicated abnormalities consistent with adrenal insufficiency.
- A morning cortisol level was significantly lower than the reference range.
Diagnostic Workup:
- Given Emily’s clinical presentation and laboratory findings, further investigations were carried out to determine the cause of her adrenal insufficiency.
- An ACTH stimulation test was performed to assess the adrenal glands’ response to synthetic ACTH. Emily’s cortisol response was suboptimal, confirming adrenal insufficiency.
- Imaging studies, including an abdominal computed tomography (CT) scan, were conducted to evaluate the adrenal glands for structural abnormalities. No significant findings were observed.
Diagnosis:
- Based on the clinical presentation, laboratory results, and ACTH stimulation test, Emily was diagnosed with primary adrenal insufficiency, also known as Addison’s disease.
Treatment:
- Emily was started on hydrocortisone replacement therapy to replace the deficient cortisol. She was instructed on how to take her medication and the importance of proper dosing.
- To address the mineralocorticoid deficiency associated with primary adrenal insufficiency, Emily was also prescribed fludrocortisone.
- Her healthcare provider emphasized the need to monitor blood pressure and electrolyte levels regularly and adjust medication dosages as needed, especially during times of stress or illness.
Outcome:
- Over the course of several weeks on cortisol and fludrocortisone replacement therapy, Emily’s energy levels gradually improved, and her fatigue diminished.
- She regained some of the lost weight and reported feeling less dizzy and more alert.
- Emily continued to follow up with her endocrinologist for ongoing monitoring and adjustment of her hormone replacement therapy to maintain optimal cortisol and mineralocorticoid levels.
This case study illustrates the clinical presentation, diagnosis, and treatment of a patient with primary adrenal insufficiency (Addison’s disease). Early diagnosis and appropriate hormone replacement therapy are crucial for managing adrenal insufficiency and improving patients’ quality of life. Monitoring and education about medication management are essential components of long-term care for individuals with this condition.
Angiotensinogen and Angiotensin in Hormonal Regulation of Blood Pressure