Cushing Syndrome: The Daily PANCE Blueprint

Home Cushing Syndrome: The Daily PANCE Blueprint

Cushing Syndrome: The Daily PANCE Blueprint

A 39-year-old woman presents with weight gain, easy bruising, and purple abdominal striae. She has central obesity, a dorsocervical fat pad, a round plethoric face, proximal muscle weakness, new hypertension, and hyperglycemia. She takes no glucocorticoids. Which of the following is the most appropriate initial screening test?

A. Random serum cortisol
B. Serum ACTH level
C. Late-night salivary cortisol (or 1-mg overnight dexamethasone suppression test)
D. Pituitary MRI
E. Adrenal CT

Answer and topic summary

The answer is C. Late-night salivary cortisol (or 1-mg overnight dexamethasone suppression test).

Central obesity, a dorsocervical fat pad, wide purple striae, proximal weakness, hypertension, and hyperglycemia point to cortisol excess (Cushing syndrome). The recommended initial screening tests are a late-night salivary cortisol, a 1-mg overnight dexamethasone suppression test, or a 24-hour urinary free cortisol — at least two should be abnormal to confirm. A single random cortisol is uninterpretable because of diurnal variation. An ACTH level and pituitary/adrenal imaging come AFTER hypercortisolism is biochemically confirmed, to localize the source.

View blueprint lesson

Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Endocrinology ⇒ Diseases of the Adrenal Glands ⇒ Cushing's Syndrome

Sign up for the ENTIRE Blueprint Daily Email Series (1000 daily questions. . . and counting! 😀)

Sign Up
X

Have you tried the NEW Smarty PANCE QBANK? It's FREE with EVERY membership purchase 😀!

Meet the new QBank! 👈
X