Cushing Syndrome

A middle-aged man presented with obesity for the previous 2 years. He is unable to stand from a squatting position and can not comb his hair. His skin is shiny and thin with normal skin color. ACTH-independent Cushing syndrome is suspected. What is the most common cause of it?

A 50-year-old male presented with recurrent episodes of abdominal pain. Ultrasound abdomen was normal, but the CT scan showed a left adrenal mass with irregular margins. Adrenal metastasis is suspected. Which of the following is the most common primary tumor resulting in adrenal metastasis?

A 40-year-old male presented with signs and symptoms of Cushing’s. It is confirmed with a low-dose dexamethasone suppression test. He has an increased ACTH level and an incomplete response to the high-dose dexamethasone suppression test. Further corticotropin-releasing hormone is administered and results in an 11% increase in cortisol level. What could be the diagnosis?

A 35-year-old female presented with a moon face, truncal obesity, easy bruising, acne, and hirsutism. Which one of the following is the confirmatory test of the underlying diagnosis?

A middle-aged male has developed obesity, cataracts, and excessive fatigue. On examination, he has a moon face, central obesity with buffalo hump with blood pressure of 150/90. He is addicted to alcohol and is taking antidepressants as well. His cortisol levels did not suppress with an overnight dexamethasone suppression test. How will you differentiate between Cushing syndrome and pseudo-Cushing syndrome?

A patient with suspected Cushing syndrome came for a review of the investigation results. Which of the following is most likely to be present in investigations?

A 50-year-old male has developed weight gain and exercise intolerance. He complained of an inability to stand from a sitting position without support. He also gave the history of easy bruising. On examination, he has central obesity, buffalo hump, and pinkish abdominal striae. What should be the best initial test?

A patient came with signs and symptoms of Cushing’s disease. An ACTH-dependent pituitary adenoma is suspected. Which test will be most reliable for its confirmation?

A 45-year-old female developed a fracture of the neck of the femur after a fall in the bathroom. Her DEXA scan shows osteoporosis. She is obese with pinkish abdominal striae. The low-dose dexamethasone suppression test is done. Her serum cortisol is 70 mmol/L after giving 1 mg of dexamethasone at 23: 00 hours. Which of the following tests will you consider the next best test to find out the cause of the abnormal result?

A 50-year-old female presented with complaints of uncontrolled hypertension. She is diabetic, and currently her diabetes is controlled with insulin and metformin. She had a history of neuropathic pain due to herpes zoster and started on carbamazepine. On examination, she has truncal obesity with acne and hirsutism. Overnight dexamethasone suppression test shows the failure of suppression of cortisol. However, further workup was not suggestive of Cushing syndrome or disease. What could be the reason for a positive screening test?

A 50-year-old male is referred to Endocrinology for uncontrolled type 2 diabetes (HbA1c 9.2%) and resistant hypertension (BP 160/100 mmHg). His medications include metformin 1g twice daily, glimepiride 4mg daily, amitriptyline for chronic back pain, and carbamazepine for trigeminal neuralgia. He reports heavy alcohol use (6–8 beers daily). Examination shows a BMI of 34 kg/m², round face, mild hirsutism, but no striae or proximal myopathy, and no abdominal masses. Investigations reveal an overnight 1mg dexamethasone suppression test (DST) with cortisol of 8 µg/dL (failed suppression), normal 24-hour urinary free cortisol (UFC), normal midnight cortisol (3 µg/dL), and normal adrenals on CT abdomen. What explains the initial false-positive dexamethasone suppression test?

A 35-year-old female presents with weight gain (15 kg over 6 months), facial rounding, and fatigue. She reports new-onset difficulty climbing stairs and lifting objects. Her BMI is 32 kg/m², and she has hypertension (BP 150/95 mmHg).

Examination Findings:

• Proximal muscle weakness(MRC grade 4/5 in the shoulder/hip girdle).
• Facial plethora and supraclavicular fat pads.
• Thin skin with easy bruising but no striae.
• No pedal edema.

Investigations:

Which clinical feature most strongly favors Cushing syndrome over obesity or pseudo-Cushing?

A Patient presented with recent onset generalized pigmentation, central obesity, easy bruising, and difficulty in standing from the sitting position. ACTH-dependent Cushing syndrome is suspected. Which of the following features indicates that ACTH secretion is from an ectopic source rather than a pituitary tumor?

A 50-year-old male known as hypertensive and obese presented with excessive fatigue. On examination, he has buffalo hump, central obesity with abdominal striae, moon face, and generalized dark pigmentation. His investigations show a random blood sugar level of 226mg/dl, high 24-hour urinary free cortisol, and serum ACTH. MRI brain shows a macroadenoma. What is the treatment of choice?

A 45-year-old female with Cushing syndrome due to an adrenal adenoma presents with uncontrolled hypertension (BP 170/100 mmHg), severe proximal myopathy, and psychotic symptoms. She is not a candidate for immediate surgery due to unstable psychiatric status.

Examination Findings:

• Moon facies, buffalo hump, and proximal muscle weakness (MRC grade 4/5).
• Psychiatric: Labile mood, paranoia.
• Labs: Hypokalemia (K⁺ 2.8 mmol/L), glucose 220 mg/dL.

Investigations:

Which medication can be used to block the systemic effects of cortisol in this patient?

A middle-aged female has developed signs and symptoms of Cushing syndrome. Her Investigations show a right adrenal adenoma. Laparoscopic adrenalectomy is planned. After surgery, how will you treat this patient?

A 45-year-old man is suffering from uncontrolled hypertension, morbid obesity, and poorly controlled diabetes. Recently, he was diagnosed with Cushing syndrome due to an adrenal cortex tumor. The patient was advised to undergo adrenalectomy after improvements in his comorbid. However, the patient is reluctant to undergo the operative procedure now. Which one is the most important next step?

A 50-year-old man developed weight gain and excessive fatigue in 5 months. He has easy bruising and difficulty standing out of the chair. Her imaging is suggestive of left adrenocortical carcinoma with no metastasis. Which one is the most appropriate treatment option for him?

A 55-year-old male presents with rapid weight gain (20 kg over 6 months), fatigue, and mood swings. He has a history of bipolar disorder (on lithium), hypertension (on losartan and hydrochlorothiazide), and chronic alcohol use (whiskey, 4–5 drinks daily).

Examination Findings:

• BP:160/92 mmHg
• BMI:36 kg/m²
• Moon facies, dorsocervical fat pad (buffalo hump), and mild abdominal striae(no violaceous discoloration).
• No proximal muscle weakness or thin skin.

Investigations:

What is the most likely diagnosis?

A patient with Cushing syndrome admitted to the ward deteriorated, and during the ward round, the house officer asked you the most common cause of death due to Cushing syndrome. How will you answer his question?

A middle-aged man presented with Cushing’s disease. Resection of pituitary macroadenoma was done, but her signs and symptoms of Cushing did not settle despite the treatment with medications. A bilateral adrenalectomy is planned. Name the risk the patient is expected to experience after this treatment?