Snapshot A 42-year-old obese woman who does not smoke presents with diastolic hypertension and menstrual irregularities. Physical exam shows a full, plethoric-appearing face, increased facial hair, truncal obesity, and purple striae around the abdomen. Scattered echymoses are present over the entire body. Labs show a Hgb of 18 g/dL and a WBC of 18,000/mm^3. The leukocyte differential shows an absolute neutrophillic leukocytosis. CXR is normal. Introduction A condition that refers to the manifestations of hypercortisolism results in hyperplasia of the adrenal cortex specifically the fasiculata There are several types iatrogenic Cushing's patients taking steroids is the most common cause of Cushing's syndrome pituitary adenoma (Cushing's disease) most common pathogenic cause (70%) majority of adenomas are benign cause bilateral hyperplasia of the adrenal glands associated increase in conversion of norepinephrine to epinephrine in medulla enzyme involved is phenylethanolamine n-methyltransferase adrenal Cushing's adenoma of the adrenals ectopic Cushing's ectopic ACTH secretion extremely high ACTH most commonly from small cell carcinoma of the lung less commonly thymic cancer Presentation Symptoms depression and psychological changes oligomenorrhea growth retardation weakness catabolism of muscle for gluconeogenesis symptoms of diabetes (polydipsia, polyuria, and dysuria) Physical exam diastolic hypertension central obesity muscle wasting thin skin that easily bruises/purple abdominal striae due to weakening of collagen hirsutism moon facies buffalo hump Evaluation Labs hyperglycemia cortisol is gluconeogenic hypokalemia at high concentrations cortisol can have partial activity at the aldosterone receptor screen for 24-hour free urinary cortisol as well as a serum cortisol level high positive and negative predictive value serum ACTH to localize lesion iatrogenic ↓ ACTH pituitary ↑ ACTH adrenal ↓ ACTH ectopic ↑ ACTH if ACTH is high, then use high dose dexamethasone suppression test pituitary ↓ cortisol production (i.e. production is suppressible) ectopic no change in cortisol (i.e. production is NOT suppressible)
QUESTIONS 1 of 5 1 2 3 4 5 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M1.EC.13.90) A 50-year-old female is evaluated by her physician for recent weight gain. Physical examination is notable for truncal obesity, wasting of her distal musculature and moon facies. In addition she complains of abnormal stretch marks that surround her abdomen. The physician suspects pituitary adenoma. Which of the following high-dose dexamethasone suppression test findings and baseline ACTH findings would support his view? Tested Concept QID: 100391 Type & Select Correct Answer 1 Cortisol suppression, normal baseline ACTH 14% (16/118) 2 Cortisol suppression, high baseline ACTH 41% (48/118) 3 No cortisol suppression, high baseline ACTH 19% (22/118) 4 No cortisol suppression, low baseline ACTH 8% (9/118) 5 Elevation of cortisol above pre-test levels, high baseline ACTH 11% (13/118) M 2 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review tested concept (M1.EC.13.74) A 35-year-old Caucasian female presents to the hospital alarmed by her recent truncal weight gain, facial hair growth, and thinning skin. During the physical exam, the physician finds that the patient is hypertensive. Serum analysis reveals hyperglycemia. The physician suspects a pituitary adenoma. Which dexamethasone test result would help confirm the physician's suspicions? Tested Concept QID: 100375 Type & Select Correct Answer 1 Low-dose, increased ACTH; high-dose, increased ACTH 6% (2/34) 2 Low-dose, increased ACTH; high-dose, decreased ACTH 12% (4/34) 3 Low-dose, decrease in ACTH; high-dose, no change in ACTH 3% (1/34) 4 Low-dose, no change in ACTH; high-dose, no change in ACTH 15% (5/34) 5 Low-dose, no change in ACTH; high-dose, decreased ACTH 65% (22/34) M 2 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review tested concept (M1.EC.13.96) A 34-year-old Caucasian female presents with truncal obesity, a rounded "moon face", and a "buffalo hump". Serum analysis shows hyperglycemia. It is determined that a pituitary adenoma is the cause of these symptoms. Adrenal examination is expected to show? Tested Concept QID: 100397 Type & Select Correct Answer 1 Atrophy of the adrenal cortex 0% (0/25) 2 Diffuse hyperplasia of the adrenal cortex 96% (24/25) 3 Atrophy of the adrenal medulla 0% (0/25) 4 Adrenal adenoma 4% (1/25) 5 Atrophy of the adrenal gland 0% (0/25) M 1 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review tested concept Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK