Adrenal Disorders Clinical Case Flashcards
Clinical Case Question
Answer
A 45-year-old woman presents with weight gain, facial rounding, hypertension, and easy bruising. She has been on long-term steroid therapy for rheumatoid arthritis. What is the most likely diagnosis?
Cushing’s syndrome (exogenous steroid use).
A 30-year-old man presents with episodes of palpitations, headaches, and sweating. His blood pressure is 180/110 mmHg. Plasma metanephrines are elevated. What is the most likely diagnosis?
Pheochromocytoma.
A 50-year-old woman with hypertension and hypokalemia has an elevated plasma aldosterone-to-renin ratio. What is the most likely diagnosis?
Primary hyperaldosteronism (Conn’s syndrome).
A 28-year-old woman presents with irregular menstruation, hirsutism, and acne. Her serum 17-hydroxyprogesterone level is elevated. What is the most likely diagnosis?
Congenital adrenal hyperplasia (21-hydroxylase deficiency).
A 60-year-old man with a history of tuberculosis presents with weakness, weight loss, hypotension, and hyperpigmentation. What is the most likely diagnosis?
Addison’s disease (primary adrenal insufficiency due to TB).
A 40-year-old woman with refractory hypertension has paroxysms of palpitations, sweating, and headaches. Urinary catecholamines and metanephrines are elevated. What is the diagnosis?
Pheochromocytoma.
A 35-year-old man with Cushing’s syndrome has undetectable ACTH and an adrenal mass on CT scan. What is the most likely cause?
Adrenal adenoma (ACTH-independent Cushing’s syndrome).
A 20-year-old woman presents with recurrent kidney stones, hypertension, and metabolic alkalosis. Plasma aldosterone is elevated, and renin is suppressed. What is the diagnosis?
Primary hyperaldosteronism.
A 50-year-old woman presents with severe postural hypotension, fatigue, and hyperpigmentation. ACTH is elevated, and cortisol is low. What is the diagnosis?
Primary adrenal insufficiency (Addison’s disease).
A 25-year-old man with known MEN2A presents with episodic hypertension, flushing, and tachycardia. What tumor should be suspected?
Pheochromocytoma.
A 55-year-old man presents with obesity, purple striae, and proximal muscle weakness. A dexamethasone suppression test shows a failure to suppress cortisol. What is the most likely cause?
Cushing’s disease (ACTH-secreting pituitary adenoma).
A 45-year-old woman presents with hypoglycemia, weakness, and postural hypotension. ACTH stimulation test shows minimal cortisol response. What is the diagnosis?
Adrenal insufficiency.
A 33-year-old woman presents with central obesity, a round face, and easy bruising. Overnight dexamethasone suppression test shows no suppression of cortisol. What is the next step?
Measure ACTH to determine if Cushing’s syndrome is ACTH-dependent or independent.
A 60-year-old man with a long history of hypertension and diabetes presents with sudden onset of severe headache, confusion, and vomiting. CT scan shows bilateral adrenal hemorrhage. What is the diagnosis?
Adrenal crisis due to Waterhouse-Friderichsen syndrome.
A 35-year-old woman presents with nausea, vomiting, hypotension, and hyperpigmentation. She recently stopped chronic prednisone use. What is the likely diagnosis?
Adrenal crisis due to secondary adrenal insufficiency.
A 70-year-old man with lung cancer presents with hyponatremia and low plasma osmolality. Serum cortisol is normal. What is the likely diagnosis?
SIADH (syndrome of inappropriate antidiuretic hormone secretion).
A 48-year-old woman presents with hypertension, hypokalemia, and metabolic alkalosis. Renin is suppressed, and aldosterone is elevated. What is the most likely cause?
Aldosterone-producing adrenal adenoma (Conn’s syndrome).
A 30-year-old man presents with episodic headaches, palpitations, and diaphoresis. His blood pressure spikes during surgery. What is the likely diagnosis?
Pheochromocytoma.
A 22-year-old woman with congenital adrenal hyperplasia has worsening hirsutism and irregular periods. What enzyme deficiency is most likely responsible?
21-hydroxylase deficiency.
A 50-year-old woman presents with moon facies, truncal obesity, and muscle wasting. A 24-hour urinary free cortisol test is elevated. What is the most likely diagnosis?
Cushing’s syndrome.
A 45-year-old woman presents with episodic hypertension, palpitations, and excessive sweating. What is the best initial screening test?
Plasma free metanephrines.
A 55-year-old man presents with fatigue, weight loss, and postural hypotension. He has a history of tuberculosis. What is the most likely diagnosis?
Primary adrenal insufficiency (Addison’s disease).
A 30-year-old woman presents with sudden-onset hirsutism, deepening voice, and clitoromegaly. Serum testosterone and DHEA-S are markedly elevated. What is the likely diagnosis?
Adrenal carcinoma.
