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Old 03-13-2013
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Question Hypercorticism establishing the cause

I have a doubt about establishing the cause of hypercorticism
If we do high dose dexamethasone suppression test then Pituitary cause of hypercorticism is excluded if the levels of cortisone are suppressed teh n why do we need to do MRI of brain and sample of inferior petrosal sinus for ACTH? should we not just do ACTH levels next to see weather hypercorticism is due to adrenal cause or ACTH producing tumor of the lung?
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Old 03-14-2013
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There diff ways of dealing with hypercortisolism:
History taking, making sure the patient is not on corticosteroids.
Dexamethasone suppression test or 24 hr urinary cortisol measurement
if positive
then it is confirmed. Check ACTH, if it is high, do a high dose dexa suppression test- if suppressed then do an MRI of the pituitary.
If not, ectopic production of ACTH is probably the cause. If ACTH is low, do a CT scan of the abdomen assuming the patient is not on corticosteroids.
It depends on ur style. There is no very accurate answer
as long as ur applying the concepts correctly.
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The above post was thanked by:
galaxy (03-14-2013), radkur (03-15-2013), usmlemydream (03-14-2013)
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Old 03-14-2013
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Thanks for the explanation what is not clear to me the role of Inferior petrosal sinus sampling?????
If you could shed some light there
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Old 03-14-2013
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Default dexamethasone suppression test

https://www.youtube.com/watch?v=pgGeHplzDpk
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