Question

A 31 year old female presents with several weeks of progressive fatigue, weakness, and weight loss. She has also had occasional nausea and diarrhea. Past medical history includes juvenile diabetes and hypothyroidism. On physical examination, the patient has areas of bronzed hyperpigmentation on her face, neck, and the dorsum of her hands. The remainder of physical exam is within normal limits. Laboratory examination is significant for a sodium of 130 mEq/L and a glucose of 65 mg/dL. Which of the following is the most appropriate next step in the diagnosis of this patient?

A. Thyroid ultrasound
B. Measurement of IGF-1
C. Measurement of 21-hydroxylase activity
D. Cosyntropin stimulation test
E. Dexamethasone suppression test

Answer 1

The most appropriate next step in the diagnosis of a patient presenting with these symptoms is the Cosyntropin stimulation test.

Step-by-step explanation:

The presentation of a 31-year-old female with progressive fatigue, weakness, weight loss, nausea, diarrhea, and hyperpigmentation on her skin suggests a possible diagnosis of adrenal insufficiency, specifically Addison's disease. The combination of hypothyroidism, juvenile diabetes, low sodium (hyponatremia), and low blood glucose (hypoglycemia) further support this diagnosis. The most appropriate next step in the diagnosis of this patient is d. Cosyntropin stimulation test, which evaluates adrenal gland function by measuring the response to synthetic ACTH.