system
Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response.
user
A 31-year-old man comes to the physician because of a 9-month history of increasing fatigue and recurrent nausea. During this period, he has had a 3.8 kg (8.3 lb) weight loss. He also reports feeling lightheaded when he stands up suddenly. He was diagnosed with alopecia areata 1 year ago and was treated with monthly intralesional triamcinolone injections for 3 months. He does not smoke or drink alcohol. His temperature is 37.4°C (99.3°F), pulse is 86/min, and blood pressure is 102/68 mm Hg. Examination of the scalp shows a few well-defined patches of hair loss without scarring. The creases of the palm are darkened. Serum studies show:
Na+ 125 mEq/L
Cl- 98 mEq/L
K+ 5.6 mEq/L
Glucose 72 mg/dL
Creatinine 0.8 mg/dL
Thyroid-stimulating hormone 4.1 μU/mL
Cortisol (AM) 2.5 μg/dL
Cortisol (30 min after 250 μg corticotropin) 2.6 μg/dL
Which of the following is the most likely underlying mechanism of this patient's symptoms?"
assistant
Autoimmune destruction of the adrenal gland