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  #1  
Old 10-09-2012
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Arrow Billy Step 1 Questions # 18

A 40-year-old man sees his physician because he has had headache, weakness, and a 5-kg weight gain over the past 3 months. He has experienced mental depression for the past 3 months and has been prescribed antidepressants. On physical examination, his face is puffy. His temperature is 36.9C, pulse is 79/min, respirations are 15/min, and blood pressure is 160/75 mm Hg while lying down. He has cutaneous striae over the lower abdomen and ecchymoses scattered over the extremities. A radiograph of the spine shows a compressed fracture of T11. Laboratory findings show a fasting plasma glucose level of 200 mg/dL, serum Na+ of 150 mmol/L, and serum K+ of 3.1 mmol/L. The plasma cortisol level is 38 μg/dL at 8:00 am and 37 μg/dL at 6:00 pm. Administration of low and high doses of dexamethasone fails to suppress the plasma cortisol level and excretion of urinary 17-hydroxycorticosteroids. The plasma corticotropin level is 0.8 pg/mL. Which of the following lesions is most likely to be present in this man?


□ (A) Adenoma of the right adrenal cortex with atrophy of the contralateral adrenal cortex
□ (B) Small-cell carcinoma of the lung with bilateral hyperplasia of the adrenal cortex
□ (C) Corticotroph adenoma of the anterior pituitary with bilateral hyperplasia of the adrenal cortex
□ (D) Adenoma of the right adrenal cortex without atrophy of contralateral adrenal cortex
□ (E) Corticotroph adenoma of the anterior pituitary, medullary carcinoma of thyroid, and bilateral nodular hyperplasia
of the adrenal cortex
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answer is either A or B

would go with B) small cell lung ca. with b/l hyperplasia of adrenal cortex..???

coz---dexamethasone not suppressing when given in low or high doses(suppresses pituitary tumor)...

Last edited by venky2600; 10-09-2012 at 08:22 AM.
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Hehe I will post the answer later
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i'll go with:

□ (A) Adenoma of the right adrenal cortex with atrophy of the contralateral adrenal cortex

Lung cancer itself produceses ACTH and it's level would have been high imo
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Default my answer :)

(A) Adenoma of the right adrenal cortex with atrophy of the contralateral adrenal cortex
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Quote:
Originally Posted by beka-CTS View Post
i'll go with:

□ (A) Adenoma of the right adrenal cortex with atrophy of the contralateral adrenal cortex

Lung cancer itself produceses ACTH and it's level would have been high imo
thanks beka-cts...got it..
changing my answer to A.......(confused with not knowing normal ACTH level)
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small cell ca Of lung causing ectopic synthesis of ACTH...
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Should we know Normal ACTH levels too!!!

I would have gone with B !

It's A now day I googled..ACTH Normal values: 9 - 52 pg/mL


Just a query will there be Calculator and Lab value table(as in UW) in actual test??
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Quote:
Originally Posted by Rookie View Post
Should we know Normal ACTH levels too!!!

I would have gone with B !

It's A now day I googled..ACTH Normal values: 9 - 52 pg/mL


Just a query will there be Calculator and Lab value table(as in UW) in actual test??
haha....atleast someone who is thinking like me
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just read endocrinology 2 days back and did mistake oohh..:sorry:
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Correct Answer A is correct

The clinical and laboratory features of this case point to Cushing syndrome. The dexamethasone suppression test is
used to localize the source of excess cortisol. When low-dose and high-dose dexamethasone trials fail to suppress cortisol
secretion, a pituitary corticotropin-secreting adenoma as the source of excess glucocorticoids is unlikely. The choice is an
ectopic source of corticotropin, such as a lung cancer, or a tumor of the adrenal cortex that is secreting glucocorticoids.
The plasma corticotropin level distinguishes between these two possibilities. Corticotropin levels are high if there is an
ectopic source, whereas glucocorticoid secretion from an adrenal neoplasm suppresses corticotropin production by the
pituitary, leading to atrophy of the contralateral adrenal cortex. An adrenal cortical adenoma that secretes aldosterone
does not cause atrophy of the contralateral adrenal cortex
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thnx 4 the question billy...that was really informative !!
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