You are called into the surgical ICU to evaluate a 21- year-old man admitted 48 hours ago after head trauma suffered during a motor vehicle accident. The patient has no past medical history. He is unresponsive, and the ICU team has had problems maintaining his blood pressure. The diagnosis of adrenal insufficiency has been entertained. Physical examination is normal. He is presently on dopamine drip. BP is 85/60, pulse 112. Laboratory evaluation shows sodium of 137, potassium of 4.0, BUN of 23, and creatinine of 1.1. The ICU team has just performed a 250 g ACTH simula- tion test. Baseline cortisol was 3.9 (g/dL); 60 minutes after 250 g of ACTH, it was 22.1. What should the next step be?

A 55-year-old disabled firefighter has a history of chronic hip pain caused by trauma in a motor vehicle accident 4 years ago. He presents to your office with symptoms of decreased libido and erectile dysfunction that began a few months after the acddent. He has no other medical history. Medications include oxycontin for pain and a multivitamin. Physical examination reveals a well-virilized man, and is notable only for mild testicular atrophy. Testosterone level is 110 ng/dL (normal 300 to 1000); prolactin level is 32 ng/dL (nor- mal 2 to 18 ng/dL). Which of the following is most likely false regarding his hypogonadism?

A 55-year-old woman sees you for a routine physical. She has no symptoms and feels well. As part of her rou- tine laboratories, a TSH is obtained and is equal to 6.50 mU/L (normal 0.5 to 4.5). You order a free T4, which is 1.0 ng/dL (normal 0.8 to 1.8). Which of the following is true?

A 35-year-old woman who is 4 months pregnant pres- ents with fatigue, weight loss, heat intolerance, and palpitations. Her physical examination reveals a nor- real-appearing woman who is somewhat anxious, but in no distress. She has a diffusely enlarged thyroid gland but no bruit. Laboratories show a TSH of less than 0.01 mU/L and a free T4 of 3.1 ng/dL (normal 0.8 to 1.8 ng/dL). Which of the following statements regarding her treatment is true?

A 61-year-old woman is seen in cardiology clinic for evaluation of a new-onset cardiomyopathy. She has had diabetes since 1986 and was being managed with glipizide 5 mg bid and metformin 1000 mg bid. At her initial visit, she was noted to have fasting triglycerides of 565 mg/dL, HbAlc of 8.8, and a creatinine of 2.8. Her heart failure was stable and she had returned to her normal level of functioning. What should be done with her therapy?