Adrenal Insufficiency

 

 

A 58-year-old woman comes to the office after she experienced a near-fainting spell 1 day ago. She was outside playing tennis when she vomited and felt
light-headed. She spent the rest of the day lying down with mild, diffuse, abdominal pain and nausea. She had no fever or diarrhea. She reports several
months of worsening fatigue, mild, intermittent, generalized abdominal pain, and loss of appetite with a 10- to 15-lb unintentional weight loss. Her medical
history is significant for hypothyroidism for which she takes levothyroxine. She takes no other medications. On examination, her temperature is 99.8°F, heart
rate is 102 bpm, blood pressure is 89/62 mm Hg, and normal respiratory rate. She does become light-headed, and her heart rate rises to 125 bpm upon
standing with a drop in systolic blood pressure to 70 mm Hg. She is alert and well tanned, with hyperpigmented creases in her hands. Her chest is clear, and
her heart rhythm is tachycardic but regular. On abdominal examination, she has normal bowel sounds and mild diffuse tenderness without guarding. Her
pulses are rapid and thready. She has no peripheral edema. Initial laboratory studies are significant for Na 121 mEq/L, K 5.8 mEq/L, HCO3 16 mEq/L, glucose
52 mg/dL, and creatinine 1.0 mg/dL.
1) What is the most likely diagnosis?
2) What is your next step?
3) What are the most common causes of primary and secondary adrenal insufficiency?
4) what is the treatment of adrenal insufficiency?
5) What is Stress dose of Steroids? dosage?

Sample Solution

Masculinity: It means to see whether emphasis is on achievement and earning. Indonesia scores low on the masculinity as compared to Australia and New Zealand that means Asian people that they prefer quality of life and not run after material things like money while in western countries during work they give high priority to the work if they have set some deadlines they tend to achieve it on the specific time. • Uncertainty Avoidance: It means to measure how people reacts to the unseen situations. Indonesia scores less on the uncertainty avoidance as compared to Australia and New Zealand. Indonesian believes that uncertainty is common in business and they do not take stress. They believe that managers should not use bad language for the staff they should overcome difficult situations with themselves and try to keep smiling how angry they are inside. While in western countries concept is opposite, managers become furious if they see unseen situations like targets are not met within deadlines. • Long term orientation: These organisations generally looks towards achieving long term objectives they are generally future oriented. Indonesian culture is long term oriented, it believes on maintaining relationship and assume that employee will remain within the company for long period, while in western countries short term orientation culture is adopted. They feel that time is precious. • Indulgence: It means how people control their own desires and children are socialised towards society. Indonesian have low indulgence as compared to Australia and New Zealand that means Indonesian people do not prefer leisure time and have control on their desires. Section 2 Indonesia Archipalego: Indonesian archipelago is unique in terms of Asia because it has many islands and having more than 245 million population and majority of the population here is Muslim. Its culture is ethnically diverse and increasingly have urbanised population (Naafs 2013). • Economic Structure: Indonesia Economy 2011 defines that every country has different economic systems. Initially Indonesia adopted liberal economic system in which communities perform economic activities. Thereafter socialist economic system came into existence, but in the new era socialist economic system again transformed into democracy economic system. This system continued until reformation and after reformation economic system based on social economy was adopted by government and still prevails in the Indonesia. Indonesian economy has seen very up and downs in the last few decades and it mostly depends upon the agriculture, manufacturing and service sectors. Agriculture is the primary sector, manufacturing comes on the secondary level and service sector is on the tertiary level (Indonesia economic structure 2010) • Religion: Indonesia investments defines that six religions are recognised officiall

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