A 32-year-old woman with hypothyroidism presented for evaluation of chronic fatigue and weight loss of 9 kg. She had no history of infections or recent travel. Physical examination revealed a body mass index of 20 (calculated as weight in kilograms divided by height in meters squared), normal vital signs, and darkening of the palmar creases and buccal mucosa. Morning laboratory tests were performed and are reported in the Table.
Hannah-Shmouni F, Demidowich A, Stratakis CA. Cortisol in the Evaluation of Adrenal Insufficiency. JAMA. 2016;316(5):535-536. doi:10.1001/jama.2016.8360