Endocrine, Physiology, USMLE Step 1 - Full Vignette with Extended Explanations скачать в хорошем качестве

Endocrine, Physiology, USMLE Step 1 - Full Vignette with Extended Explanations

A 49-year-old woman with common variable immunodeficiency and restrictive cardiomyopathy presents with progressive fatigue, salt craving, dizziness, confusion, and significant electrolyte disturbances, accompanied by specific skin changes and orthostatic symptoms. Laboratory evaluation reveals hyponatremia, hyperkalemia, low cortisol response, and abnormal ACTH findings. What pathophysiological processes in the adrenal cortex could explain this clinical scenario, and which clues on presentation help us understand the underlying disease? VIDEO INFO Category: Endocrine, Physiology, USMLE Step 1 Difficulty: Expert - Expert level - For those seeking deep understanding Question Type: Pathology Case Type: Rare Presentation Explore more ways to learn on this and other topics by going to https://endlessmedical.academy/auth?h... QUESTION A 49-year-old woman with common variable immunodeficiency receiving monthly IVIG and restrictive cardiomyopathy presents from assisted living with 2 days of progressive fatigue, nausea, orthostatic dizziness, and confusion. She reports intermittent salt craving for months, unintentional 5-kg weight loss, early satiety, and intermittent diarrhea. She denies any glucocorticoid use.... OPTIONS A. Autoimmune adrenalitis with lymphocytic infiltration, cortical atrophy, and 21-hydroxylase autoantibody association, with predominant destruction of zona fasciculata and zona reticularis and early mineralocorticoid deficiency. B. Waterhouse-Friderichsen-type bilateral adrenal hemorrhagic necrosis due to fulminant bacterial sepsis with widespread cortical hemorrhage and medullary involvement causing abrupt adrenal failure. C. Metastatic small cell carcinoma infiltrating both adrenal glands, producing adrenal enlargement with mass effect and subacute adrenal failure from cortical replacement. D. Pituitary macroadenoma with apoplexy causing secondary adrenal insufficiency characterized by low ACTH, normal or low aldosterone, and absence of generalized skin hyperpigmentation. CORRECT ANSWER A. Autoimmune adrenalitis with lymphocytic infiltration, cortical atrophy, and 21-hydroxylase autoantibody association, with predominant destruction of zona fasciculata and zona reticularis and early mineralocorticoid deficiency. EXPLANATION "Autoimmune adrenalitis with lymphocytic infiltration, cortical atrophy, and 21-hydroxylase autoantibody association, with predominant destruction of zona fasciculata and zona reticularis and early mineralocorticoid deficiency." - This option is correct because the patient has hypotension, hyperpigmentation, hyponatremia with hyperkalemia, hypoglycemia, eosinophilia, very low morning cortisol that fails to rise after cosyntropin, and a massively elevated ACTH-all classic for primary adrenal insufficiency. High renin with low aldosterone indicates mineralocorticoid deficiency; CT shows small adrenals rather than enlargement or hemorrhage, matching chronic autoimmune adrenalitis. Teaching point: autoimmunity with 21-hydroxylase antibodies is the leading cause of Addison s in high-income countries; small adrenals and lymphocytic destruction predominate histologically. "Waterhouse-Friderichsen-type bilateral adrenal hemorrhagic necrosis due to fulminant bacterial sepsis with widespread cortical hemorrhage and medullary involvement causing abrupt adrenal failure." - This typically presents with overt septic shock, DIC, and enlarged hemorrhagic glands on imaging, which are absent.... Further reading: Links to sources are provided for optional further reading only. The questions and explanations are independently authored and do not reproduce or adapt any specific third-party text or content. --------------------------------------------------- Our cases and questions come from the https://EndlessMedical.Academy quiz engine - multi-model platform. Each question and explanation is forged by consensus between multiple top AI models (i.e. Open AI GPT, Claude, Grok, etc.), with automated web searches for the latest research and verified references. Calculations (e.g. eGFR, dosages) are checked via code execution to eliminate errors, and all references are reviewed by several AIs to minimize hallucinations. Important note: This material is entirely AI-generated and has not been verified by human experts; despite stringent consensus checks, perfect accuracy cannot be guaranteed. Exercise caution - always corroborate the content with trusted references or qualified professionals, and never apply information from this content to patient care or clinical decisions without independent verification. Clinicians already rely on AI and online tools - myself included - so treat this content as an additional focused aid, not a replacement for proper medical education. Visit https://endlessmedical.academy for more AI-supported resources and cases. This material can not be treated as medical advice. May contain errors. ---------------------------------------------...