The patient’s family history is very significant because they have suffered from the auto immune diseases associated with the Addison’s disease. For instance hashimoto thyroiditis and the grave disease suffered by both sisters are some of the risk factors. The father died of a cardiac arrest which is also a risk factor for this disease. These conditions hint that the disease could be generic (Brook, Clayton, & Brown, 2009).
The patient is taking cyanocobalamin because she was treated Appendicitis surgicaly, this could be hindering the absorption of vitamin B12 in her body. Lack of this could have resulted in her weak immune system (Brooke & Monson, 2009).
Oral cyanocobalamin is not recommendable for this patient because it has nausea as a side effect. The patient is already suffering from nausea and therefore the situation could be worsened by this condition. Similarly, swelling of the face is also a side effect, if administered oraly the patient may swell her face further yet her face is already swollen. The patient is also anemic and this could interfere with anemia treatment and harm the patient (Brooke & Monson, 2009).
Variance in blood pressure and heart readings due to the change in position explains the fact that a little activity like standing makes the patient tired. This explains why she can no longer participate in her favorite outdoor activities. She has a lot of fatigue (Brooke & Monson, 2009).
Pigmentation of the skin is the greatest risk factor for this patient (Brooke & Monson, 2009).
The most likely cause of Addison disease for this patient is the surgery performed 10 years ago. This could have altered the functioning of the adrenal glands which are located just above the kidneys (Hertl, 2011).
It is unlikely that tuberculosis caused the addison’s disease in this patient because the lungs are clear and normal (Donald, 2010).
The two most significant test results for Addison disease are; the low level of cortisol in the blood (2.0 jig/dl). The minimum level for a normal person is 8 jig/dl. The moderate billeteral atrophy in the adrenal glands is also another test that confirmed the Addison disease in this patient (Brooke & Monson, 2009).
It is advisable to administer fludrocortisone because the patient has low levels of sodium in the blood (Brook, Clayton & Brown, 2009).
This patient has fatigue which is a major sign of hypothyroidism (Brooke & Monson, 2009).
Fifteen clinical signs of Addison include;
Weak pedal pulses
Low levels of Sodium in the blood
Low blood pressure
Dry mucous membrane
Aches and pains (Brooke & Monson, 2009).
The single test that confirms Addison is the Rapid ACTH stimulation test on cortisol assay (Brooke & Monson, 2009).
Iron deficiency is not the cause for anemia because;
The volume of RBCs is normal; the peripheral blood smear performed indicates that the erythrocytes are normal and the patient did not experience shortness in breath which is common for other causes of anemia. The adrenal glands had a moderate bilateral atrophy common in Addison (Brooke & Monson, 2009).
The patients anemia is not as a result of vitamin B12 deficiency because; The volume of the white blood cells is normal and the external female genital is normal (Brooke & Monson, 2009).
Shotty lymphadenopathy is a consistent diagnosis for this patient because of the CT scan which indicated that the adrenal glands had a moderate bilateral atrophy (Brooke & Monson, 2009).
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