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CPE-008 · synthetic case ADR-FX-19
Potassium 6.4, sodium 126 and hyperpigmentation
Severe metabolic derangement.
Purpose: Severe metabolic derangement.
Inputs the engine received
Chemistry and vitals
- Age
- 36 years
- Sodium
- 126 mmol/L
- Potassium
- 6.4 mmol/L
Symptoms and signs
- Fatigue
- Yes
- Hyperpigmentation (skin, scars, gums, palmar creases)
- Yes
What the engine reports
Potassium of 6.0 mmol/L or more, or glucose below 54 mg/dL, together with other adrenal features needs urgent assessment.
Detected clinical pattern
Urgent Review Finding
A safety rule calls for urgent clinical assessment. Read the safety findings first.
- Pattern: screening indicated
Recommended next steps
For physician consideration. Urgent review always comes first.
- 1Urgent assessment of severe hyperkalemia or hypoglycemia with adrenal features.
- 2Order an 8 am cortisol with ACTH; add renin and aldosterone when primary insufficiency is suspected.Endocrine Society 2016.
- 3Order an 8 am cortisol with ACTH.
Differentials, pitfalls and contradicting signals
- Hyperpigmentation has other causes (sun exposure, other endocrine and dermatologic conditions); it is a clue, not a diagnosis.
Missing information
- 8 am cortisol and ACTH.
Evidence and rule trace · 3 rules
AI-01Clinical and laboratory pattern that justifies testing
Inputs: sodium 126 · potassium 6.4 · fatigue · hyperpigmentation
Screening opportunity: measure an 8 am cortisol with ACTH.
AI-02Hyperpigmentation
Inputs: hyperpigmentation documented
A strong clue to primary adrenal insufficiency; testing is warranted.
AI-SAFE-01Severe hyperkalemia or hypoglycemia with an adrenal clue
Inputs: potassium 6.4 · sodium 126 · potassium 6.4
Urgent assessment: severe metabolic derangement with adrenal features.
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.
- EV-RUSHWORTH-2019 · Rushworth RL, Torpy DJ, Falhammar H. Adrenal Crisis. N Engl J Med. 2019;381(9):852-861.
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-03
Salt craving and dizziness on standing
Low sodium.
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.
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