BOF: 45
A 56-year-old male presents with a history of feeling
tired and weak. On examination he is obese and has marked pigmentation of his
skin. Blood pressure 190/110. he also has demonstrable weakness of his
proximal muscles .
Investigations reveal
Urea 5 mmol/L
Sodium 140 mmol/L
Potassium 2.7 mmol/L
Bicarbonate 32 mmol/L
Glucose 12 mmol /L
In this patient which one of the following would you
arrange as the initial investigation?
a)
Adrenal MRI
b)
24 hour urinary free cortisol
c)
High dose dexamethasone suppression test
d)
Plasma ACTH levels
e)
CRH test
Answer: b)
The clinical features would suggest Cushing’s syndrome.
The investigations show a hypokalaemic metabolic alkalosis. This together with
elevated blood glucose adds further weight to the initial suspicion that the
patient has Cushing’s syndrome
The initial investigation should be to confirm the
suspicion raised clinically and by the routine investigations. The other tests
would determine the cause of the disease.
Revision Tip
Revise Cushing’s syndrome KEYS
to SUCCESS in Medicine page 50-52
