Pathology EMQ.

Name: Aseel Al-Ansari

Theme: Adrenals

OPTION LIST

A	Primary ovarian failure	I	Reminder to wear steroid card
B	Bromocriptine therapy	J	Pituitary dependent disease
C	Adrenal tumour	K	Cushing’s syndrome
D	Trans-sphenoidal removal of tumour	L	Next morning at 0900h and then at 2400h
E	External pituitary irradiation of tumour	M	Congenital adrenal hyperplasia
F	After 48 hours in hospital at 0900h and 2400h	N	Ectopic source of cortisol
G	Immediately	O	Take alternate day steroid therapy
H	Stop steroids	P	Increase steroid dose

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. A 40 year old obese shop-owner is noted in A+E to have hypertension, multiple bruises and muscle weakness. He complains of low mood and back pain. He is admitted to the endocrine ward. When should a cortisol sample be taken?

2. A 47 year old man with striae and proximal myopathy undergoes a high dose dexamethasone suppression test. On day 2 of the test, his cortisol reading is a third of what it was on day 0. What is the most likely diagnosis?

3. A middle aged lady with known Cushing’s disease catches influenza and goes to see her GP. Other than bed rest and fluids, what piece of advice should she be given?

4. A mildly hypotensive pre-pubertal girl presents with acne and increased hair growth. What is the most likely diagnosis?

5. What is the treatment option of choice for a patient with pituitary dependent Cushing’s disease?

ANSWERS

1. F

2. J

3. P

4. M

5. D