Problem:
A 38-year-old man presents with two months of arthralgias, nausea, abdominal pain and fatigue. On exam he has significant orthostatic changes in his systolic blood pressure, he has hyperpigmentation of his palmar creases and buccal mucosa. The serum (Na) is 124 mmol/L and the urine (Na) is 66 mmol/L. The serum am cortisol is 7 mcg/dL. On adrenocorticotropic hormone (ACTH) stimulation testing, the cortisol level at 60 minutes is 11 mcm/dL. The ACTH level is a ACTH- 130 pmol/L (normal range is 4.5 and 12 pmol/L). Which of the following conditions is/are in your differential diagnosis to explain this patients hyponatremia? Select all that apply.
1. Tuberculosis
2. Exogenous corticosteroids use
3. Autoimmune adrenalitis
4. Antiphospholipid syndrome