Pathology I

Question 1

What is Cushing’s syndrome?

Answer 1

Increased cortisol due to a variety of causes (p.296)

Question 2

What is the number one cause of Cushing’s syndrome?

Answer 2

Exogenous (iatrogenic) steroids (p.296)

Question 3

What is the distinguishing lab feature of iatrogenic Cushing’s syndrome?

Answer 3

Low ACTH (p.296)

Question 4

Name three endogenous causes of Cushing’s syndrome.

Answer 4

Cushing’s disease (70%), ectopic ACTH production (15%), Adrenal causes (15%) (p.296)

Question 5

What is Cushing’s disease?

Answer 5

High cortisol levels due to increased ACTH secretion from a pituitary adenoma. ACTH levels are high (p.296)

Question 6

What lab finding is consistent with Cushing’s disease?

Answer 6

High ACTH (p.296)

Question 7

What causes Cushings syndrome due to ectopic ACTH production?

Answer 7

Non-pituitary tissue making ACTH. ACTH is high (p.296)

Question 8

Name two malignancies which are associated with ectopic ACTH production.

Answer 8

Small cell lung cancer, bronchial cardinoids (p.296)

Question 9

What causes Cushings syndrome due to adrenal causes?

Answer 9

Adenoma, carcinoma, nodular adrenal hyperplasia. ACTH levels are low. (p.296)

Question 10

What lab finding is consistent with Cushing’s syndrome due to ectopic ACTH production?

Answer 10

High ACTH (p.296)

Question 11

What lab finding is consistent with Cushing’s syndrome due to adrenal causes?

Answer 11

Low ACTH (p.296)

Question 12

What are the typical clinical findings in a patient with Cushing’s syndrome?

Answer 12

Hypertension, weight gain, moon facies, truncal obesity, buffalo hump, hyperglycemia (insulin resistance), skin changes (thinning, striae), osteoperosis, amenorrhea, immune suppression (p.296)

Question 13

What effect does the dexamethasone suppression test have on cortisol in low doses have on a healthy individual?

Answer 13

Suppresses cortisol levels (p.296)

Question 14

What effect does the dexamethasone suppression test have on cortisol in low doses have on a patient with an ACTH pituitary tumor?

Answer 14

Cortisol remains elevated (p.296)

Question 15

What effect does the dexamethasone suppression test have on cortisol in low doses have on a patient with an ectopic ACTH-producing tumor?

Answer 15

Cortisol remains elevated (p.296)

Question 16

What effect does the dexamethasone suppression test have on cortisol in low doses have on a patient with a cortisol-producing tumor?

Answer 16

Cortisol remains elevated (p.296)

Question 17

What effect does the dexamethasone suppression test have on cortisol in high doses have on a healthy individual?

Answer 17

Suppresses cortisol levels (p.296)

Question 18

What effect does the dexamethasone suppression test have on cortisol in high doses have on a patient with an ACTH pituitary tumor?

Answer 18

Suppresses cortisol levels (p.296)

Question 19

What effect does the dexamethasone suppression test have on cortisol in high doses have on a patient with an ectopic ACTH-producing tumor?

Answer 19

Cortisol remains elevated (p.296)

Question 20

What effect does the dexamethasone suppression test have on cortisol in high doses have on a patient with a cortisol-producing tumor?

Answer 20

Cortisol remains elevated (p.296)

Question 21

Name two common presentations in a patient with an adrenocortical adenoma.

Answer 21

Cushing’s Syndrome; Conn’s syndrome (p.296)

Question 22

Name two causes of primary hyperaldosteronism.

Answer 22

Adrenal hyperplasia; an aldosterone-secreting adrenal adenoma (Conn’s Syndrome). May be bilateral or unilateral (p.296)

Question 23

Name four symptoms of primary hyperaldosteronism.

Answer 23

Hypertension, hypokalemia, metabolic alkalosis, low plasma renin (p.296)

Question 24

What is the treatment for primary hyperaldosteronism?

Answer 24

Surgery to remove the tumor and/or spironolactone (p.296)

Question 25

What is the mechanism of action of spironolactone?

Answer 25

A potassium sparing diuretic that works by acting as an aldosterone antagonist (p.296)

Question 26

What pathologic endocrine conditions is spironolactone used to treat?

Answer 26

Primary and secondary hyperaldosteronism (p.296)