A 42-year-old man comes to the physician for a 2-month history of worsening shortness of breath on exertion. He has no past medical history. Cardiac examination shows an S3 heart sound. Echocardiography shows a left ventricular ejection fraction of 50%. Serum studies show: K+ 4.5 mEq/L; HCO3– 25 mEq/L. Blood pressure is 150/100. He takes no medications. A photograph of his forearm is shown.
Which of the following is the most likely explanation for this patient’s findings?
Adrenal cortical autoimmunity
Adrenal medullary autoimmunity
Anterior pituitary autoimmunity
Increased bone turnover
Increased intestinal absorption
