Endocrinology and diabetes: secondary adrenal insufficiency features: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Endocrinology and diabetes: secondary adrenal insufficiency features

Sample item

A 45-year-old woman took prednisolone 20 mg daily for eight months for giant cell arteritis and stopped it abruptly. She now has fatigue, nausea and postural hypotension. Which finding would be expected compared with primary adrenal failure?

ARaised plasma renin with salt cravingBNormal potassium without hyperpigmentationCHyperkalaemia from aldosterone deficiencyDRaised ACTH with darkened palmar skin creases

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Normal potassium without hyperpigmentation

Long-term glucocorticoids suppress the pituitary-adrenal axis, so ACTH is low and the zona glomerulosa, which depends on the renin-angiotensin system, is spared. There is no hyperpigmentation and potassium is normal. Primary failure raises ACTH, causing pigmentation, and loses mineralocorticoid.

Option by option

A. Raised plasma renin with salt craving
Raised renin with salt craving reflects mineralocorticoid loss in primary failure.
B. Normal potassium without hyperpigmentation (correct)
Correct. Low ACTH explains the absent pigmentation, and mineralocorticoid function is preserved.
C. Hyperkalaemia from aldosterone deficiency
Hyperkalaemia needs aldosterone deficiency, which is preserved here.
D. Raised ACTH with darkened palmar skin creases
Raised ACTH occurs in primary adrenal disease, not with pituitary suppression.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is B, Normal potassium without hyperpigmentation. Long-term glucocorticoids suppress the pituitary-adrenal axis, so ACTH is low and the zona glomerulosa, which depends on the renin-angiotensin system, is spared.

Why is "Raised plasma renin with salt craving" not the answer?

Raised renin with salt craving reflects mineralocorticoid loss in primary failure.

Why is "Hyperkalaemia from aldosterone deficiency" not the answer?

Hyperkalaemia needs aldosterone deficiency, which is preserved here.

Why is "Raised ACTH with darkened palmar skin creases" not the answer?

Raised ACTH occurs in primary adrenal disease, not with pituitary suppression.

What concept does this question test?

It tests Endocrinology and diabetes: secondary adrenal insufficiency features in General Medicine. There is no hyperpigmentation and potassium is normal. Primary failure raises ACTH, causing pigmentation, and loses mineralocorticoid.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Endocrinology and diabetes: secondary adrenal insufficiency features?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.