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CPE-008 · synthetic case ADR-FX-03
Salt craving and dizziness on standing
Low sodium.
Purpose: Low sodium.
Inputs the engine received
Chemistry and vitals
- Age
- 52 years
- Sodium
- 131 mmol/L
Symptoms and signs
- Orthostatic dizziness
- Yes
- Salt craving
- Yes
What the engine reports
Detected clinical pattern
Screening Opportunity: Measure Cortisol and ACTH
The pattern justifies an 8 am cortisol with ACTH. The features are individually non-specific and establish nothing alone.
Recommended next steps
For physician consideration. Urgent review always comes first.
- 1Order an 8 am cortisol with ACTH; add renin and aldosterone when primary insufficiency is suspected.Endocrine Society 2016.
Missing information
- 8 am cortisol and ACTH.
Evidence and rule trace · 2 rules
AI-01Clinical and laboratory pattern that justifies testing
Inputs: sodium 131 · orthostatic dizziness · salt craving
Screening opportunity: measure an 8 am cortisol with ACTH.
AI-03Salt craving
Inputs: salt craving documented
Salt craving can reflect mineralocorticoid deficiency.
Evidence
- EV-ES-PAI-2016 · Bornstein SR, Allolio B, Arlt W, et al. Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016;101(2):364-389.
- EV-HUSEBYE-2014 · Husebye ES, Allolio B, Arlt W, et al. Consensus statement on the diagnosis, treatment and follow-up of patients with primary adrenal insufficiency. J Intern Med. 2014;275(2):104-115.
Physician adjudication required. Clinical decision support for physician review. This output identifies laboratory patterns and safety situations. It does not diagnose adrenal insufficiency, name a glucocorticoid dose, or replace emergency treatment. Physician adjudication is required.
Change the values
The same engine, starting from this case. Change any value and watch the pattern and the rule trace react.
Cortisol testing
- <5 very likely
- 5–14.9 indeterminate
- ≥15 unlikely
46 pg/mL is assumed when empty.
Chemistry and vitals
Symptoms and signs
Exposures, history and context
More adrenal cases
ADR-FX-01
Low sodium, high potassium, weight loss and nausea
A 44-year-old with hyperpigmented scars.
ADR-FX-02
Hyperpigmentation and fatigue
No labs yet.
ADR-FX-04
Cortisol 2.1 with ACTH 180
Low cortisol and high ACTH: a primary pattern.
ADR-FX-05
Morning cortisol 9 µg/dL
Indeterminate.
ADR-FX-06
Morning cortisol 17 µg/dL
Unlikely.
ADR-FX-07
Stimulated peak cortisol of 11 µg/dL
Insufficient response.
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