A patient presents with hyperpigmentation mild hypotension hyponatremia and hyperkalemia. Blood tests show elevated plasma CRH and elevated ACTH. The etiology is the A) pituitary B) adrenal cortes and this is classified as A) cushings disease B) addisons disease. The patient would likely have A) depressed B) elevated levels of plasma glucose.
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- Hyperpigmentation suggests an issue with adrenal or pituitary function, as it is a common sign of Addison's disease (adrenal insufficiency). - Mild hypotension can be associated with both Cushing's disease and Addison's disease, but in Addison's, it is more Show more…
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A 32-year-old woman presented to the clinic complaining of weight gain, swelling in her legs and ankles, and a puffy face. She also recently developed hypertension and diabetes type 2. She noted poor short-term memory, irritability, excess hair growth (in women), a red-ruddy face, extra fat around her neck, fatigue, poor concentration, and menstrual irregularity, in addition to muscle weakness. Given her physical appearance and history, a tentative diagnosis of hypercortical function was made. Diagnostics included serum and urinary cortisol and serum adrenocorticotropic hormone (ACTH) levels. MRI revealed a pituitary adenoma. Question: How would you differentiate Cushing's disease from Cushing's syndrome?
Adi S.
Part A If the anterior pituitary is responsible for hyperthyroidism, the level of TSH will be reduced along with the levels of T3 and T4, which are the thyroid hormones; the level of TRH from the hypothalamus will be elevated. Part B In a nonfunctioning adenoma of the corticotrophs, which are the cells that secrete ACTH, the CRH level will be reduced, and the cortisol level will be reduced. Part C Cushing’s disease is caused by a pituitary adenoma, resulting in an increase in blood cortisol; Cushing’s syndrome is an elevated cortisol level as the result of some other cause. If a patient has an elevated cortisol level and they are found to have a tumor of the adrenal cortex, the condition would be diagnosed as Cushing’s syndrome.
Madhur L.
Read the patient's health information (below): Temp: 98.6; HR: 70; RR: 16; BP: 150/94. Gen: WDWN, NAD. A&Ox3. HEENT: NCAT. PERRLA. White sclera. No conjunctival injection. Mucous membranes moist and pink. Normal dentition. Neck: Supple. No LAD. Enlarged fat pad over extensor surface of neck. Resp: CTA without wheezes, rales, or rhonchi. CV: RRR without murmurs, gallops, or rubs; radial pulse 21. Abd: Soft, nontender, nondistended. No masses. Striae over abdomen. Neuro: CN II-XII grossly intact. No focal neurologic deficit. Ext: Feet pink and warm. No cyanosis, clubbing, or edema. Skin: Mild increase in hair growth over lip and chin. Tests revealed low ACTH, increased cortisol, hyperlipidemia, and hyperglycemia. Which of the following is an accurate interpretation of the patient's health information? Tests revealed low adrenocorticotropic hormone, and excessive fat and sugar in the blood.
Dominador T.
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