Pathology EMQ template.

Name: Maartje Ament

Theme: Adrenal

OPTION LIST

A	Pituitary dependent Cushing’s disease	I	Secondary adrenal insufficiency
B	Adrenal tumour causing Cushing’s syndrome	J	Primary hyperaldosteronism
C	Ectopic ACTH causing Cushing’s syndrome	K	Secondary hyperaldosteronism
D	Normal obese person	L	Adrenal medulla
E	Cushing’s syndrome of indeterminate cause	M	Zona glomerulosa
F	Pituitary adenoma	N	Zona fasciculata
G	Phaeochromocytoma	O	Zona reticularis
H	Primary adrenal insufficiency

For each scenario below, choose the most appropriate answer from the list above. Each option may be used once, more than once or not at all.

1. 36-year old male presents with hypertension. Lab results: Na⁺ = 155mmol/L, K⁺ = 2.9mmol/L, pH = 7.46, low plasma renin activity.

2. 50-year old female with the following lab results: Na⁺ = 130mmol/L, K⁺ = 5.9mmol/L, glucose = 3.4mmol/L, urea = 7.2 mmol/L, Ca²⁺ = 2.8 mmol/L. A short SynACTHen test shows cortisol = 600nmol/L half an hour after administration.

3. A 45-year old female patient presents with cushingoid features. A dexamethasone suppression test shows undetectable ACTH, cortisol = 750nmol/L.

4. A 65-year old male patient presents with cushingoid features. A high dose dexamethasone suppression test shows ACTH 25 pmol/L (high), cortisol = 750nmol/L.

5. A 28-year old man presents with hypertensive episodes. Lab results: Na+ 140mmol/L, K+ = 4.1mmol/L, random cortisol = 200nmol/L. CT shows an adrenal mass, which region is most likely to be affected?

ANSWERS

1. J

2. I

3. B

4. C

5. L