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A 57-year-old female is brought to the emergency room by her…

 

A 57-year-old female is brought to the emergency room by her husband. Over the past several days, she has  complained of abdominal pain and nausea, which has been associated with occasional vomiting. During the past  two days, she has been much more sleepy than normal. She has no significant past medical history, other than  temporal arteritis. Her vital signs are a temperature of 99.0°F, pulse of 113 bpm, and blood pressure of 91/61 mm Hg. Her ACTH is 4 pg/mL, and her cortisol is 1 μg/dL. Despite treatment, she goes into cardiac arrest and cannot be resuscitated. An autopsy reveals atrophic adrenal glands. Of the following, what was the most likely  mechanism of her disease process?

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a. Infection with Neisseria meningitidis 

b. Use of anticoagulants

c. Rapid withdrawal of exogenous steroids

d. Neoplastic infiltration of adrenal gland

e. Antimitochondrial antibodies

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