Too Dry for Primary Adrenal Insufficiency (PAI): PAI Masked by Volume Depletion.

Adrenal insufficiency (AI) is a rare but potentially life-threatening endocrine disorder characterized by inadequate production or impaired response to adrenal hormones. Symptoms may range from acute emergent crisis presenting as hemodynamic shock or may be more chronic in presentation with a gradual onset of nonspecific symptoms. These vague symptoms are often accompanied by typical laboratory findings, such as hyponatremia, hypotension, and hyperkalemia, and point toward a diagnosis of chronic AI. In this case presentation, we demonstrate chronic AI presenting with severe hyponatremia, which was revealed after return to an euvolemic baseline. Because of an insidious presentation, AI can be both an incidental finding and easily missed. This case highlights the importance of evaluating suspected cases of AI at a baseline metabolic and hemodynamic state, including volume status. High clinical suspicion is warranted in these patients to avoid potential emergent adrenal crisis and to provide appropriate replacement therapy once etiology is established.

Building a strong foundation from the ground up: the impact of a medical student substance use disorder organization on curriculum and community.

Due to the increasing rates of substance use disorders (SUDs), accidental overdoses, and associated high mortality rates, there is an urgent need for well-trained physicians who can grasp these complex issues and help struggling patients. Preparing these physicians occurs through targeted education and clinical exposure in conjunction with medical school curricula in the field of addiction medicine. Medical students can often feel overwhelmed by the medical school curriculum and changes to the curriculum take time, money, and administrative commitment to ratify. Implementing a student organization dedicated to SUD education can be a solution to provide clinical exposure, education and student autonomy in their medical school experience. At Wayne State University School of Medicine, Detroit vs. Addiction (DvA) is a student-run organization that is filling the gap in SUD education for medical students whilst providing assistance to the community. DvA not only extends clinical education for physicians in training, but it also provides the medical school with an opportunity to allow students to create a blueprint for education initiatives that can be incorporated as a mainstay in the school's technical trainings. Herein, we describe the evolution of this organization and its activities.