QuestionSBA
QuestionChoice
This is incorrect. This is a test for pheochromocytoma. Fatigue, weight loss and bronzing of the palmar creases are classic signs of adrenal insufficiency. An ACTH (short synacthen) test is the gold standard investigation to confirm the diagnosis.
10027539
d
Plasma metanephrines
QuestionChoice
This is incorrect. This is a test for Cushing's syndrome. Fatigue, weight loss and bronzing of the palmar creases are classic signs of adrenal insufficiency. An ACTH (short synacthen) test is the gold standard investigation to confirm the diagnosis.
10027538
c
Low dose dexamethasone suppression test
QuestionChoice
This is incorrect. This is a test for acromegaly. Fatigue, weight loss and bronzing of the palmar creases are classic signs of adrenal insufficiency. An ACTH (short synacthen) test is the gold standard investigation to confirm the diagnosis.
10027537
b
IGF1
QuestionChoice
This is incorrect. This is a test used when hyperaldosteronism or Conn's is suspected. Fatigue, weight loss and bronzing of the palmar creases are classic signs of adrenal insufficiency. An ACTH (short synacthen) test is the gold standard investigation to confirm the diagnosis.
10027540
e
Aldosterone/Renin ratio
QuestionChoice
This is correct. Fatigue, weight loss and bronzing of the palmar creases are classic signs of adrenal insufficiency. Hyponatraemia and hyperkalaemia, as well as postural hypotension, are also characteristic. A significant autoimmune past medical history also makes primary adrenal insufficiency (Addison's disease) more likely. The short synacthen test is the gold standard investigation to confirm the diagnosis of adrenal insufficiency. Her 9 am cortisol level would most likely be low.
10027536
a
Short synacthen test
Concept
Chapter
2693
5988
Adrenal Insufficiency and Addison's
Topic
133
Endocrinology
17905
A 30 year old female presents to her GP surgery with extreme fatigue for the past 6 months. She also report bouts of abdominal pain over this time that are accompanied by nausea, and has lost approximately 6kg unintentionally over this time. The only medication they take is levothyroxine for Hashimoto's thyroiditis. They have no other past medical history.

On examination, there is bronzing to the skin of their palms. Observations are within normal limits except for their blood pressure which is 126/82 when lying down and 100/71 when standing.

Their blood results are as follows:

Glucose 3.9mmol.
Sodium 130.
Potassium 5.7.
Normal thyroid panel.

Which of the following is the next best investigation?
a