A 34-year-old female presents with hyperpigmentation, postural hypotension, fatigue, hyponatremia, and hyperkalemia. What test confirms primary adrenal insufficiency?
Answer and explanation
Correct answer: A. Cosyntropin ACTH stimulation test
- Step 1: Cutaneous hyperpigmentation and concurrent mineralocorticoid deficiency (hyponatremia and hyperkalemia) indicate primary adrenal insufficiency (Addison disease).
- Step 2: The diagnostic gold standard is the short cosyntropin (synthetic ACTH) stimulation test; failure of serum cortisol to rise above 18 mcg/dL confirms adrenal cortical failure.
Answer
Cosyntropin ACTH stimulation test.
Why not the others: The dexamethasone suppression test evaluates hypercortisolemia in suspected Cushing syndrome. The aldosterone-to-renin ratio screens for primary aldosteronism. Plasma catecholamines screen for pheochromocytoma.
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