SOLVED2588

A 19-year-old woman with a history of attention-deficit hyperactivity disorder, depression, and anxiety presented with 1 week of extreme fatigue, dizziness, and episodic nausea and vomiting. She endorsed multiple episodes of presyncope over the prior month, as well as increasing fatigue, weakness, and exhaustion that limited her ability to ambulate. She also noted increasing darkness of her gums over the past 6-9 months. Family history was notable for multiple sclerosis in her grandmother. On presentation, she was afebrile, hypotensive to 71/41 mm Hg (baseline 100s/60s), mildly tachycardic with a heart rate of 102 beats per minute, and had oxygen saturations of 100% on room air with a respiratory rate of 18 breaths per minute. Her examination showed hyperpigmentation of the skin,
SCIENCE
HEALTH SCIENCE
NURSING

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