These questions are designed to be a brief active review of the previous two topics. If for some reason something doesn’t make sense or you want to go back and check something click here for a Addison’s disease and here for Cushing’s syndrome.
1. The answer is A.
- Approximately 80% of cases in the U.S. are secondary to autoimmune problems.
- In countries where TB is a problem it can be a major cause.
- See answer A
- See answer A
2. The answer is D
- an elevated CRF will cause an elevated ACTH in order to produce cortisol
- As ACTH goes up so should serum cortisol
- This may be the case a secondary adrenal insufficiency where the pituitary is not functioning properly and not responding to CRF
- An elevated ACTH with a low cortisol is diagnostic for adrenocortical insufficency.
3. The answer is Cushing’s syndrome. With the excess steroid these patients get a central obesity including a buffalo hump and moon face.
4. The answer is D
- Cortisol levels should be tested, but they are not diagnostic. Serum cortisol may be elevated for any number of reasons including a stress response.
- Serum ACTH may be elevated, normal or even low in Cushing’s syndrome depending on the cause of the disease.
- A dexamethasone suppression test is a good test for Cushing’s but not the best
- A 24 hour urine collection with a free cortisol > 125 µg/dl is diagnostic.
5. The answers are A, B and D – these are symptoms of Cushing’s disease.
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