hero
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A 63-year-old woman recently developed diabetes and hypertension. She has gained 4.4 kg (10 lb) in the past year. She was previously healthy and had four successful pregnancies by 35 years of age. On physical examination, the patient is 155 cm (61 in) tall and weighs 70 kg (154 Ib). Blood pressure is 140/90 mm Hg. She has mild hair growth on her upper lip, moderate acanthosis nigricans in the folds of her neck, prominent supraclavicular fat pads, and mild central obesity. The 24-hour urine cortisol excretion is 411 μg. The 8:00-AM. serum cortisol level is 26 μg/dL after taking 1 mg of dexamethasone at bedtime and 8.2 μg/dL after taking 8 mg of dexamethasone at bedtime. The plasma adrenocorticotropic hormone level is 50 pg/mL. (9 to 52 is normal)
What test should be ordered next?
A. CT scan of the adrenal glands
B. MRI of the pituitary gland
C. CT scan of the lungs
D. Bilateral inferior petrosal sinus sampling for adrenocorticotropic hormone
E. Octreotide scan
Edited by hero on 01/03/08 - 09:52 PM
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| anastamosis
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| DRamarnath
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c.
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| cool doctor
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| arlete
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| Ivonne
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- 24 hours urine free cortisol: VN: <80-120(this patient has 411)
- After 1mg: . >10 strongly cushing(pt has 26)
- After 8mg: If plasma cortisol decrease more than 50%------------->Cushing disease(pt has 8.2 that has decreased>50% of 26)
Edited by Ivonne on 01/04/08 - 02:14 PM
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| multifactorial
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b
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| Ivonne
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Don't forget to post the right answer pz
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