A 32-year-old woman presented with amenorrhea of 9 months’ duration. Physical examination fi ndings were unremarkable except for bilateral expressible galactorrhea. Laboratory test results included a negative pregnancy test, evidence of a hypogonadotropic state, and a prolactin level of 250 ? g/L. Findings on magnetic resonance imaging of the pituitary were consistent with a pituitary microadenoma. Th e patient was unable to tolerate dopaminergic-agonist drugs, and a decision was made to treat her surgically. On the second day aft er transsphenoidal microadenomectomy, postoperative diabetes insipidus developed but resolved by the third postoperative day. Her medications at dismissal included an analgesic and replacement doses of hydrocortisone. She was instructed in hydrocortisone dosage modifi cations during an acute illness. A week aft er her hospital dismissal, she was evaluated in an emergency department for headache, fatigue, lethargy, confusion, and nausea. She had been taking her medications regularly. Physical examination fi ndings were unremarkable. Which of the following is the most important laboratory test to perform? a. Pregnancy test b. Serum free thyroxine c. Serum cortisol d. Serum sodium e. Serum prolactin

 

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