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Old 03-11-2013
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Default few queries regarding MTB-2

Hello guys, first of all, Good luck on your Preps for CK

MTB-Ck, 2nd edition, page no-120
the approach for hypercortisolism: says

1) 24 hr urine cortisol level/ low dose dexa suppression test for establishing the presence of cushing syndrome. I am ok with it

2) ACTH level 2 distinguish, Primary(adrenal source) Vs Cushings disease(pituitary tumor)/ Ectopic secretion(pulmonary) again am ok wid it

3) Then a high dose dexa suppression test, which should distinguish between Cushings disease Vs Ectopic,

Here is the problem,
the book says when it doesn't suppress with high dose dexa
d next approach is to 1) scan the Pituitary with MRI 2) inferior petrosal sinus with CRH stimulation if the MRI scan is negative to look for a pituitary source.
only if both are negative, then screen the lungs

My qstn is 'failure to suppress after a high dose dexa' points towards points towards ectopic(pulmonary), yes? then whats the point of checking the pituitary for tumor first?
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