Mariam is a 10-year-old with intermediate risk medulloblastoma post end of treatment (complete surgical resection, chemotherapy and radiation) 6 months ago. She presented to Emergency Room with mild vomiting, hypothermia, left sided weakness and numbness with slurred speech. She has chronic anorexia and weight loss over the last 6 month. No headache. No other new onset symptoms. Vital signs: temperature 34, heart rate: 40, blood pressure 110/60, respiratory rate 20, SaO2 100% on room air. Glucose 79. TSH 9, Free T4: 1.5. What is your most likely diagnosis?
- Hypothyroidism?
- Recurrent tumor?
- Adrenal insufficiency?
- Sepsis?
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