Assessment of Cushing syndrome and Cushing disease: Pathology review | Osmosis

Question

A 58-year-old man comes to the emergency department because of fatigue and a cough that is productive of blood-tinged sputum. His symptoms began four months ago. Past medical history is notable for emphysema and hypertension. He has a 40-pack-year smoking history. Physical examination reveals 4/5 strength in the bilateral upper and lower extremities. Ecchymoses and striae are noted on the abdomen. Laboratory testing reveals a fasting blood glucose of 147 mg/dL. Chest X-ray shows a mass in the perihilar region of the left lung. A 24-hour urine sample reveals an elevated cortisol level. A high-dose dexamethasone test is subsequently ordered as part of the patient&#8217;s work-up. Which of the following ACTH levels would be expected before and after the high-dose dexamethasone is administered? &#160;

Accepted Answer

Before High-Dose Dexamethasone After High-Dose Dexamethasone
Increased Increased

Answer

Before High-Dose Dexamethasone After High-Dose Dexamethasone
Decreased Decreased

Answer

Before High-Dose Dexamethasone After High-Dose Dexamethasone
Decreased Increased

Answer

Before High-Dose Dexamethasone After High-Dose Dexamethasone
Increased Decreased

Answer

Before High-Dose Dexamethasone After High-Dose Dexamethasone
Normal Decreased

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Cushing syndrome and Cushing disease: Pathology review

Pathology

Endocrine system