Great catch/case. I wonder what led the the cortisol level testing in the first place? Not very clear from the case presentation, or maybe I missed? Was it just the lowish blood pressure? The hypokalemia can be a confounding factor. Up until the BM bx, I was leaning towards some myeloproliferative disorder.
Beautiful case presentation, workup, and discussion. Unfortunately, patients with substance abuse in this stage usually present with a multitude of symptoms all calling for thorough workup as completed here and the urgent need for rapid workup before these patients leave AMA. I didn't see if with negative HIV & cancer w/u whether her prealbumin/albumin levels were low enough to explain the observed malnutrition (poor dentition, esophageal candidiasis, & low weight).
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Great catch/case. I wonder what led the the cortisol level testing in the first place? Not very clear from the case presentation, or maybe I missed? Was it just the lowish blood pressure? The hypokalemia can be a confounding factor. Up until the BM bx, I was leaning towards some myeloproliferative disorder.
Beautiful case presentation, workup, and discussion. Unfortunately, patients with substance abuse in this stage usually present with a multitude of symptoms all calling for thorough workup as completed here and the urgent need for rapid workup before these patients leave AMA. I didn't see if with negative HIV & cancer w/u whether her prealbumin/albumin levels were low enough to explain the observed malnutrition (poor dentition, esophageal candidiasis, & low weight).