The patient who gave a positive test for 21-hydroxylase in Q3. is a 46-year-old woman. She is complaining of weakness, fatigue, loss of appetite and weight loss, increase in thirst and increased urination. She also suffered occasional dizziness, particularly when standing. She has no prior medical history and is not taking any medication. On examination, supine blood pressure was normal, but a marked postural hypotension was noted on standing. Following some basic blood tests (see below), the GP makes a provisional diagnosis of Addison’s Disease. Variable Result Reference Range Urea (mM) 7.55 2.5 - 7.0 Creatinine (mM) 82 60 - 120 Glucose (mM) 3.25 3.5 - 5.5 (fasting) Na+ (mM) 119 134 -147 K+ (mM) 6.8 3.5 - 5.0 Cortisol (nM) 48 138 - 690 ACTH (pM) 236 < 26 Aldosterone (pM) 27 90 - 700 The patient was referred by the GP for follow up tests with the endocrinologist. The tests included measurements of cortisol, ACTH and aldosterone levels (shown in the table) and also the test for antibodies against 21-hydroxylase. a) Using the the data in the table, the test results from the follow up with the endocrinologist and the test for autoantibodies against 21-hydroxylase, do you agree or disagree with the provisional diagnosis by the GP? Briefly explain your answer.
The patient who gave a positive test for 21-hydroxylase in Q3. is a 46-year-old woman. She is complaining of weakness, fatigue, loss of appetite and weight loss, increase in thirst and increased urination. She also suffered occasional dizziness, particularly when standing. She has no prior medical history and is not taking any medication. On examination, supine blood pressure was normal, but a marked postural hypotension was noted on standing. Following some basic blood tests (see below), the GP makes a provisional diagnosis of Addison’s Disease.
|
Variable |
Result |
Reference Range |
|
Urea (mM) |
7.55 |
2.5 - 7.0 |
|
Creatinine (mM) |
82 |
60 - 120 |
|
Glucose (mM) |
3.25 |
3.5 - 5.5 (fasting) |
|
Na+ (mM) |
119 |
134 -147 |
|
K+ (mM) |
6.8 |
3.5 - 5.0 |
|
Cortisol (nM) |
48 |
138 - 690 |
|
ACTH (pM) |
236 |
< 26 |
|
Aldosterone (pM) |
27 |
90 - 700 |
The patient was referred by the GP for follow up tests with the endocrinologist. The tests included measurements of cortisol, ACTH and aldosterone levels (shown in the table) and also the test for antibodies against 21-hydroxylase.
a) Using the the data in the table, the test results from the follow up with the endocrinologist and the test for autoantibodies against 21-hydroxylase, do you agree or disagree with the provisional diagnosis by the GP? Briefly explain your answer.
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