Which electrolyte abnormalities are typical in primary adrenal insufficiency?

Which electrolyte abnormalities are typical in primary adrenal insufficiency?

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

Answer: (A)

In primary adrenal insufficiency, the lack of aldosterone disrupts mineralocorticoid action in the kidneys. Aldosterone normally promotes sodium reabsorption and potassium excretion in the distal nephron. When it’s deficient, sodium is lost in urine, water follows, and hyponatremia can develop. At the same time, potassium isn’t secreted efficiently, leading to hyperkalemia. Cortisol deficiency can further worsen hyponatremia by increasing ADH release, but the hallmark pattern remains low sodium with high potassium. Hypernatremia would be unlikely because sodium loss rather than retention occurs, and hypokalemia would not fit this scenario since potassium excretion is reduced.

In primary adrenal insufficiency, the lack of aldosterone disrupts mineralocorticoid action in the kidneys. Aldosterone normally promotes sodium reabsorption and potassium excretion in the distal nephron. When it’s deficient, sodium is lost in urine, water follows, and hyponatremia can develop. At the same time, potassium isn’t secreted efficiently, leading to hyperkalemia. Cortisol deficiency can further worsen hyponatremia by increasing ADH release, but the hallmark pattern remains low sodium with high potassium. Hypernatremia would be unlikely because sodium loss rather than retention occurs, and hypokalemia would not fit this scenario since potassium excretion is reduced.