Post on 03-Mar-2018
7/26/2019 Dexamethasone Test
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A 22 year old female with clinical suspicion for hypercortisolism is seen by the endocrinologist for follow
up after obtaining laboratory work. In addition to her Cushinoid features, all of the lab results are consistent
with hypercortisolism. She is now in your office to discuss the results and the next step in
management. Her laboratory results are as follows.:
Adrenocorticotropic hormone: low
Urine free cortisol: ElevatedCortisol (8 AM)
After 1 mg of dexamethasone the night before: Elevated
After 8 mg of dexamethasone the night before: Elevated
What test do you order next?
Serum/urine catecholamine
CT scan of the head
CT Scan of the abdomenMRI of the head
Cosyntropin stimulation test
Your answer is correct
This is a patient with suspected hypercortisolism. With low ACTH and cortisol leels that are notsuppressed after hi!h and low dose de"amethasone suppression test# one of the suspicions isthat the patient has an ectopic adrenal nodule that is responsible for the results shown aboe. $nthe contrary# patients who hae pituitary adenomas resultin! in Cushin!s will hae eleated
ACTH# eleated urine free cortisol# and hi!h de"amethasone suppression test will partiallydepress the cortisol leel. Thus# in this patient# one of the areas to ealuate is the adrenal !landby obtainin! CT Scan of the abdomen.
7/26/2019 Dexamethasone Test
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