Which combination of electrolyte abnormalities is most typical in adrenal insufficiency?

Which combination of electrolyte abnormalities is most typical in adrenal insufficiency?

• A. Hyponatremia with hyperkalemia
• B. Hypernatremia with hypokalemia
• C. Hyponatremia with hypokalemia
• D. Hypernatremia with hyperkalemia

Answer: (A)

In adrenal insufficiency, especially primary disease, there is a deficiency of aldosterone. Aldosterone normally promotes sodium reabsorption and potassium excretion in the kidney. Without it, you lose sodium (hyponatremia) and retain potassium (hyperkalemia). Cortisol deficiency can also raise ADH, promoting water retention and further lowering sodium. So the typical pattern is hyponatremia with hyperkalemia. Hyperkalemia is less common in secondary adrenal insufficiency because aldosterone is preserved there, though hyponatremia can still occur due to ADH effects. The other combos don’t fit with the main disrupted hormonal axis in adrenal insufficiency, which is aldosterone-driven salt wasting and potassium retention.

In adrenal insufficiency, especially primary disease, there is a deficiency of aldosterone. Aldosterone normally promotes sodium reabsorption and potassium excretion in the kidney. Without it, you lose sodium (hyponatremia) and retain potassium (hyperkalemia). Cortisol deficiency can also raise ADH, promoting water retention and further lowering sodium. So the typical pattern is hyponatremia with hyperkalemia. Hyperkalemia is less common in secondary adrenal insufficiency because aldosterone is preserved there, though hyponatremia can still occur due to ADH effects. The other combos don’t fit with the main disrupted hormonal axis in adrenal insufficiency, which is aldosterone-driven salt wasting and potassium retention.