Which laboratory findings are most consistent with acute adrenal insufficiency?

• A. Hyponatremia and hyperkalemia
• B. Hypernatremia and hypokalemia
• C. Hypoglycemia only
• D. Hyperglycemia only

Answer: (A)

Deficiency of aldosterone in acute adrenal insufficiency disrupts how the kidneys handle sodium and potassium. Without aldosterone, the distal tubules reabsorb less sodium and excrete less potassium, leading to hyponatremia and hyperkalemia. Volume depletion from salt loss also contributes to low sodium and to symptoms of shock. Cortisol deficiency can cause hypoglycemia, but the most characteristic electrolyte pattern is low sodium with high potassium, which is why those findings are most consistent. Hypernatremia with hypokalemia, hypoglycemia only, or hyperglycemia only do not fit the typical renal effects of acute adrenal crisis.