Differential Diagnosis
- Single most likely diagnosis
- Primary adrenal insufficiency: The patient's symptoms of weight loss, hypotension, and trouble managing blood glucose levels are consistent with primary adrenal insufficiency. The low c-peptide and insulin levels also support this diagnosis, as adrenal insufficiency can lead to impaired glucose regulation.
- Other Likely diagnoses
- Late-onset type 1 diabetes: The patient's low c-peptide and insulin levels, along with difficulty managing blood glucose levels, could suggest late-onset type 1 diabetes. However, the presence of hypotension and hypokalemia makes primary adrenal insufficiency a more likely diagnosis.
- Adrenal insufficiency with concomitant diabetes: It is possible that the patient has both primary adrenal insufficiency and a form of diabetes, which could explain the combination of symptoms.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Addisonian crisis: A life-threatening complication of primary adrenal insufficiency, characterized by severe hypotension, hypoglycemia, and electrolyte imbalances. Prompt recognition and treatment are crucial to prevent mortality.
- Pheochromocytoma: A rare tumor of the adrenal gland that can cause hypotension, weight loss, and glucose dysregulation. Although unlikely, it is a potentially life-threatening condition that should not be missed.
- Rare diagnoses
- Congenital adrenal hyperplasia: A rare genetic disorder that can cause adrenal insufficiency and glucose dysregulation. However, it typically presents in childhood, making it less likely in this case.
- Autoimmune polyendocrine syndrome: A rare condition characterized by multiple autoimmune disorders, including adrenal insufficiency and diabetes. Although possible, it is a rare diagnosis that would require further evaluation to confirm.