VS: Sitting BP 108/70 mm Hg, sitting P 74 bpm, RR 14 breaths/min, standing BP 96/ 68, standing P 86, wt 68 kg (150 lb), ht 5'5" (165 cm)

Skin: Hyperpigmentation on creases of palms and around breast nipples, darkening of scar of left leg

CV: RRR, normal Si, S2; no murmurs, rubs, or gallops

Labs: Serum electrolytes: sodium 132 mEq/L (132 mmol/L), potassium 5.2 mEq/L (5.2 mmol/L), chloride 98 mEq/L (98 mmol/L), bicarb 30 mEq/L (30 mmol/L), blood urea nitrogen (BUN) 25 mg/dL (8.9 mmol/L), creatinine 1.2 mg/dL (106 ^mol/L), glucose 120 mg/dL (6.7 mmol/L).

Which signs or symptoms of adrenal insufficiency does AB exhibit?

Does AB s presentation offer any clues as to the etiology or classification of adrenal insufficiency?

Which tests would be most useful for determining the etiology and confirming the diagnosis of adrenal insufficiency?

• Patients with secondary and tertiary adrenal insufficiency are treated with oral hydrocortisone or a longer-acting glucocorticoid in the same manner as previously described for primary adrenal insufficiency. However, patients with secondary and tertiary adrenal insufficiency may require a lower dose. Some patients will only require glucocorticoid replacement temporarily, which can be discontinued after recovery of the HPA axis (e.g., patients with drug-induced adrenal insufficiency or adrenal insufficiency following treatment for Cushing's syndrome). Progression of the underlying etiology for the adrenal insufficiency should be monitored. Fludrocortisone therapy is generally not needed.

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