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Old 12-05-2012
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Arrow A 14-year-old boy on corticosteroids

A 14-year-old boy presents at the pediatric clinic for a routine checkup. The patient had developed end-stage renal disease over the previous 2 years, and was successfully treated with a renal transplant 6 months prior. Since his operation, he has developed purple striae on his back and arms, central obesity, and an increasingly round face. During the subsequent blood analysis, which of the following results would be most likely?

CHOICE ACTH URINARY FREE CORTISOL
A
B ↓ normal
C
D
E

(A) A
(B) B
(C) C
(D) D
(E) E

Last edited by heartbeat; 12-05-2012 at 11:49 PM.
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Old 12-06-2012
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both will decrease as exogenous steroids with suppress ACTH so decrease production of cortisol.
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Old 12-06-2012
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Option A.

Both ACTH and free cortisol would decrease cuz of the presence of exogenous steroids.
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Old 12-06-2012
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so the urine test does not measure exogenous steroids ???
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Quote:
Originally Posted by Hitman View Post
so the urine test does not measure exogenous steroids ???
Elevated baseline urinary free cortisol levels can result from situations of acute stress (eg, hospitalization, surgery), from alcoholism, from depression, and as a side effect of many drugs (eg, exogenous cortisones, anticonvulsants).

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Cross-reactivity with some exogenous glucocorticoids (eg, prednisone) can occur, depending on the assay method (radioimmunoassay, high-performance liquid chromatography, or liquid chromatography–tandem mass spectrometry [LC-MS/MS]), used, which may lead to falsely increased urinary free cortisol levels. The preferred assay is LC-MS/MS because it eliminates analytical interferences with substances such as carbamazepine (Tegretol) and synthetic corticosteroids that may affect immunoassay-based cortisol results.
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Yup ans A is correct
I had misconception that exogenous steroids are associated with elevated level of urinary free cortisol..
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