A 28-Year-Old Man Comes to the Emergency Department Due to a 2-Day

question 589

Multiple Choice

A 28-year-old man comes to the emergency department due to a 2-day history of polyuria, polydipsia, abdominal pain, nausea, and vomiting.  He was diagnosed with primary adrenal insufficiency 6 months ago after developing fatigue and weight loss.  The patient was started on hydrocortisone and fludrocortisone at that time, resulting in improvement of symptoms and return to baseline weight.  Medical history is otherwise unremarkable.  The patient's mother had Graves disease treated with radioiodine, and his sister has hypothyroidism.  Family history is negative for diabetes mellitus.  The patient does not use tobacco, drinks "a few beers on weekends," and used marijuana occasionally during college.  Temperature is 36.9 C (98.4 F) , blood pressure is 90/65 mm Hg, pulse is 115/min, and respirations are 22/min.  BMI is 22 kg/m².  Oral mucous membranes are dry, and the abdomen shows mild diffuse tenderness with no peritoneal signs.  Laboratory results are as follows: What is the most likely cause of this patient's hyperglycemia?

• A)Glucocorticoid-induced diabetes mellitus
• B)Maturity-onset diabetes of the young
• C)Pancreatitis-induced diabetes mellitus
• D)Type 1 diabetes mellitus
• E)Type 2 diabetes mellitus

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