A 45-year-old lady complains of weakness amenorrhea, mood changes, weigh gain and easy bruising. She also notices a worsening of her type 2 Diabetes mellitus and hypertension control. She only uses hydrochlorothiazide and metformin. On physical examination, she has a full rounded face, central obesity and wide reddish striae. To confirm the diagnosis, which test would you consider?
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الإجابة: A. 1 mg Dexamethasone suppression test
Moon face, central obesity, wide purple striae, bruising, amenorrhoea and worsening diabetes/HTN suggest Cushing's syndrome. Step 1 is to confirm hypercortisolism with a screening test — the overnight 1 mg dexamethasone suppression test is the most used initial test.
- Salivary cortisol must be late-night, not early morning (C) — morning cortisol is normally high.
- AM cortisol + ACTH (B) and pituitary MRI (E) belong to the later step of finding the cause, after confirmation.
ليش كل خيار صح أو غلط
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A
ليش صح
Step 1 is to confirm Cushing syndrome, and the overnight dexamethasone suppression test is the most used confirmatory test.
✓ Endocrine ✳️.pdf · p. 24 -
B
ليش غلط
ACTH is measured in step 2, to ask whether the cause is ACTH-dependent or independent, after Cushing syndrome has been confirmed.
✓ Endocrine ✳️.pdf · p. 24 -
C
ليش غلط
The salivary test listed for confirming Cushing syndrome is late-night salivary cortisol, not early-morning.
✓ Endocrine ✳️.pdf · p. 24 -
D
ليش غلط
Hypernatremia, hypokalemia and metabolic alkalosis are only supporting lab findings in Cushing syndrome; confirmation needs cortisol testing.
✓ Adrenal disorders (2).pdf · p. 9 -
E
ليش غلط
Pituitary MRI is step 3, done after a positive high-dose dexamethasone test points to Cushing disease, not to confirm the diagnosis.
✓ Endocrine ✳️.pdf · p. 24
- المصدر
- Endocrine ✳️.pdf · p. 24
Adrenal disorders (2).pdf · p. 9 - المحاضرة
- Cushing's Syndrome · Endocrinology · Module B
- ظهر في
- Endo bank · MED41 ♀ EOM B