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Question 1: A 75-year-old woman presented with a 4-week history of lethargy. Her medical history was
unremarkable and she took no medication.
On examination, her blood pressure was 140/70 mmHg lying. She was euvolaemic.
Investigations:
serum sodium120 mmol/L (137-144)
serum potassium3.8 mmol/L (3.5-4.9)
serum urea3.0 mmol/L (2.5-7.0)
serum creatinine75 umol/L (60-110)
short tetracosactide ([email protected]) test (250 micrograms):
baseline serum cortisol450 nmol/L (200-700)
serum cortisol (30 min after tetracosactide)600 nmol/L (>550)
serum thyroid-stimulating hormone2.5 mU/L (0.4-5.0)
serum free T416.9 pmol/L (10.0-22.0)
urinary sodium70 mmol/L
What is the most appropriate initial management?
A. demeclocycline
B. fluid restriction
C. hydrocortisone
D. intravenous sodium chloride 0.9%
E. tolvaptan
Correct Answer: B
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10 days ago

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