Turner White CommunicationsAbout TWCSubscribeContact TWCHomeSearch
Hospital PhysicianJCOMSMPBRMsCart
Current Contents
Past Issue Archives
Interactive:
Self-Assessment Questions
Review of
Clinical Signs
Clinical Review
Quiz
Pediatric Rounds
Resident Grand Rounds
Article Archives
Case Reports
Clinical Practice
Exams
Pediatric Rounds
Resident Grand Rounds
Review of
Clinical Signs

Guide to Reading
Hospital Physician
Editorial Board
Information for Authors

Reprints, Permissions, & Copyright
Site Map

Review of Clinical Signs Review Questions

Cushing’s Syndrome

Bernard M. Karnath, MD

Choose the single best answer to each question.

1. A 25-year-old woman has experienced a 20-lb weight gain and has had increased fat accumulation in her face and trunk over the past 6 months. She has also noted gradually progressive acne, hirsutism, weakness, and oligomenorrhea. On physical examination, blood pressure is 150/90 mm Hg. She has central obesity, acne on her face, hirsutism, and violaceous striae on her abdomen. Laboratory evaluation includes an overnight 1 mg dexamethasone study, which reveals an 8:00 AM serum cortisol level of 30 µg/dL. What is this patient’s most likely diagnosis?

  1. Addison’s disease
  2. Congenital adrenal hyperplasia (CAH)
  3. Conn’s disease
  4. Cushing’s syndrome
  5. Polycystic ovary syndrome (PCOS)
Click here to compare your answer.


2. A 40-year-old woman presents for a follow-up appointment after being diagnosed with diabetes and hypertension 6 months ago. Review of systems reveals a 20 lb weight gain over the past year. On physical examination, blood pressure is 160/90 mm Hg. She has mild hair growth on her upper lip, prominent supraclavicular fat pads, and central obesity with violaceous abdominal striae. The 24-hour urine cortisol excretion is 450 µg (normal, 20-100 µg/24 h). Baseline 8:00 AM cortisol is 35 µg/dL (normal, 5-25 µg/dL). Low-dose dexamethasone suppression testing (2 mg/day over 2 days) reveals an 8:00 AM serum cortisol level of 30 µg/dL. High-dose dexamethasone suppression testing (8 mg/day over 2 days) reveals an 8:00 AM serum cortisol level of 10 µg/dL. Plasma adrenocorticotropin hormone (ACTH) level is 40 pg/mL (normal, 9-52 pg/mL). What test should be ordered next?

  1. Bilateral inferior petrosal sinus sampling
  2. Computed tomography (CT) of the adrenal glands
  3. CT of the lungs
  4. Magnetic resonance imaging (MRI) of the pituitary gland
  5. Pelvic ultrasound
Click here to compare your answer.


3. A 50-year-old man reports fatigue and weakness for the past 6 months. He has a 40 pack-year history of smoking. On physical examination, blood pressure is 140/90 mm Hg, and he has central obesity, enlarged supraclavicular fat pads, and prominent violaceous abdominal striae. The 24-hour urine cortisol excretion is 300 µg. Serum cortisol level is 30 µg/dL at baseline, 29 µg/dL at 8:00 AM after low-dose dexamethasone suppression testing, and 28 µg/dL at 8:00 AM after high-dose dexamethasone suppression testing. Plasma ACTH is 280 pg/mL (normal, 20-100 pg/mL). What is the most likely source of hypercortisolism in this patient?

  1. Adrenal glands
  2. Hypothalamus
  3. Lungs
  4. Pancreas
  5. Pituitary gland
Click here to compare your answer.


4. A 25-year-old woman presents for evaluation of hirsutism. She reports gradual development of facial hair over the past 5 years. She had menarche at age 13 years, and her menses have been irregular since that time. She took oral contraceptive pills for birth control from age 15 to 20 years. On physical examination, height is 65 in and weight is 170 lb. She has scattered acne on her face and hair on her upper lip. The remainder of her examination, including her pelvic examination, is normal. Laboratory evaluation reveals a testosterone level of 150 ng/dL (normal, 6-86 ng/dL), luteinizing hormone (LH) level of 25 mIU/mL (normal, 10-31 mIU/mL), follicle-stimulating hormone (FSH) level of 7 mIU/mL (normal, 6-17 mIU/mL), and fasting glucose level of 135 mg/dL (normal, 70-110 mg/dL). What is this patient’s most likely diagnosis?

  1. Addison’s disease
  2. CAH
  3. Conn’s disease
  4. Cushing’s syndrome
  5. PCOS
Click here to compare your answer.


5. A 20-year-old woman presents with irregular menstrual periods and increasing body hair. Menarche occurred at age 14 years, and her periods have been irregular since this time. Physical examination reveals moderate hirsutism. The pelvic examination is normal. Laboratory testing reveals a dehydroepiandrosterone sulfate (DHEAS) level of 2800 ng/mL (normal, 130-980 ng/dL), LH level of 14 mIU/mL, FSH level of 9 mIU/mL, 17-hydroxyprogesterone level of 540 ng/dL (normal, 100-250 ng/dL), and testosterone level of 110 ng/dL. Serum cortisol level is 4 µg/dL. What is this patient’s most likely diagnosis?

  1. Addison’s disease
  2. CAH
  3. Conn’s disease
  4. Cushing’s syndrome
  5. PCOS
Click here to compare your answer.

Click here to read more about Cushing’s Syndrome (Requires Adobe Acrobat Reader)


Review of Clinical Signs main page



Check our archives to test your knowledge in other clinical signs:

Review of Clinical Signs Archives


If you do not already have Acrobat Reader, simply click on the icon below, scroll down to the "Get the Free Acrobat Reader" heading and follow the instructions to install the program. Acrobat enables you to convert any document into an Adobe Portable Document Format (PDF) file for easy viewing.

Download Adobe Acrobat Reader

 

Hospital Physician     JCOM     Seminars in Medical Practice
Hospital Physician Board Review Manuals
About TWC    Subscribe    Contact TWC    Home    Search   Site Map

Copyright © 2009, Turner White Communications
Updated 4/17/08 • nvf