What is the diagnosis for a 36-year-old patient with a history of double lung transplant, recent influenza A infection, thyroiditis, and adrenal insufficiency, presenting with elevated Thyroid-Stimulating Hormone (TSH) levels and hypotension?

Differential Diagnosis for 36 yo Double Lung Transplant Patient

Single Most Likely Diagnosis

• Adrenal crisis: The patient's history of adrenal insufficiency, combined with the recent flu, thyroiditis, and current presentation of hypotension and elevated TSH, makes adrenal crisis the most likely diagnosis. The stress of the flu and thyroiditis could have exacerbated the adrenal insufficiency, leading to a crisis.

Other Likely Diagnoses

• Thyroid storm: Although the patient has thyroiditis, which could lead to a thyroid storm, the elevated TSH suggests hypothyroidism rather than hyperthyroidism. However, thyroid storm is still a possibility, especially if the thyroiditis is causing a release of pre-formed thyroid hormones.
• Sepsis: The recent flu and immunocompromised state due to the double lung transplant increase the risk of sepsis, which could cause hypotension and elevated TSH.
• Rejection of lung transplant: The patient's immunocompromised state and recent illness increase the risk of rejection, which could cause hypotension and other systemic symptoms.

Do Not Miss Diagnoses

• Pituitary apoplexy: Although rare, pituitary apoplexy could cause adrenal insufficiency, thyroiditis, and hypotension. It is a life-threatening condition that requires prompt diagnosis and treatment.
• Meningitis: The patient's immunocompromised state increases the risk of meningitis, which could cause hypotension, fever, and other systemic symptoms.
• Cardiac tamponade: The patient's recent lung transplant and immunocompromised state increase the risk of cardiac tamponade, which could cause hypotension and other cardiac symptoms.

Rare Diagnoses

• Polyglandular autoimmune syndrome: This rare condition could cause adrenal insufficiency, thyroiditis, and other autoimmune disorders.
• Fungal infection: The patient's immunocompromised state increases the risk of fungal infections, which could cause hypotension, fever, and other systemic symptoms.
• Cytokine release syndrome: This rare condition could cause hypotension, fever, and other systemic symptoms, especially in immunocompromised patients.