A 9-year-old boy presented with history of recurrent vomiting, lethargy, brown pigmentation of gum and skin crease with growth failure. Test results: Sodium 130 (134-146 mmol/L),... A 9-year-old boy presented with history of recurrent vomiting, lethargy, brown pigmentation of gum and skin crease with growth failure. Test results: Sodium 130 (134-146 mmol/L), Potassium 6 (3.5-5.1 mmol/L), Calcium total 3 (2.2-2.7 mmol/L), BUN 11 (0.7-6.7 mmol/L Newborn, 1.8 to 6.4 mmol/L Child), Creatinine 80 (27-88 mol/L Newborn, 27-62 mol/L, Child), Prolactin 800 (<652 pmol/L Male, <870 pmol/L Female), Cortisol 8 a.m. 66 (138-635 mol/L). Which of the following is the best management option? A. Daily thyroxine B. Daily vitamin D C. Daily vitamin B6 D. Daily hydrocortisone
Understand the Problem
The question describes a 9-year-old boy presenting with symptoms and lab results indicative of a specific endocrine disorder. We need to analyze the patient's presentation, focusing on the abnormal lab values (sodium, potassium, calcium, BUN, creatinine, prolactin and cortisol) in relation to the symptoms (recurrent vomiting, lethargy, brown pigmentation, growth failure). Based on this analysis, determine the most appropriate management option from the choices provided (thyroxine, vitamin D, vitamin B6, or hydrocortisone). This requires understanding the potential underlying condition based on the symptoms and lab results.
Answer
The best management option is daily hydrocortisone.
The best management option is daily hydrocortisone, as the boy's symptoms and test results suggest adrenal insufficiency (Addison's disease).
Answer for screen readers
The best management option is daily hydrocortisone, as the boy's symptoms and test results suggest adrenal insufficiency (Addison's disease).
More Information
The symptoms and lab findings are consistent with primary adrenal insufficiency (Addison's disease). Hyperpigmentation, particularly in the gums and skin creases, is a classic sign due to increased ACTH. Low sodium, high potassium, and low cortisol levels further support this diagnosis. Hydrocortisone is a glucocorticoid replacement that addresses the cortisol deficiency.
Tips
A common mistake is to not recognize the classic signs of Addison's disease (hyperpigmentation) and the electrolyte imbalances (low sodium, high potassium). Always consider endocrine disorders when presented with vague symptoms like vomiting, lethargy, and growth failure.
Sources
- An 11-year-old boy with vomiting, dehydration, and a tan complexion - pubmed.ncbi.nlm.nih.gov
- [PDF] Oral Pigmentation as a Sign of Addison's Disease: A Brief Reappraisal - opendermatologyjournal.com
- Addisonian Pigmentation of the Oral Mucosa - MDEdge - cdn-uat.mdedge.com
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