can someone explain this please ?
MSRA Community
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23 Apr 2024
hyperpigmentation and cushing
Question:
A 45-year-old female presents to her primary care physician with complaints of weight gain, easy bruising, and a round, "moon-shaped" face. She also reports irregular menstrual cycles and excessive hair growth on her face and body. On physical examination, she has central obesity, purple striae on her abdomen, and thin skin. Laboratory studies reveal elevated serum cortisol levels and lack of suppression of cortisol with low-dose dexamethasone suppression test. Additionally, her plasma ACTH levels are found to be elevated. Which of the following features would suggest an ectopic source of ACTH as the underlying cause of her condition?
Options:
A)Productive Cough
B)Hyperpigmentation
C)Central obesity
D)Hypertension
E)Bowel habit change
hyperpigmentation and cushing
Question:
A 45-year-old female presents to her primary care physician with complaints of weight gain, easy bruising, and a round, "moon-shaped" face. She also reports irregular menstrual cycles and excessive hair growth on her face and body. On physical examination, she has central obesity, purple striae on her abdomen, and thin skin. Laboratory studies reveal elevated serum cortisol levels and lack of suppression of cortisol with low-dose dexamethasone suppression test. Additionally, her plasma ACTH levels are found to be elevated. Which of the following features would suggest an ectopic source of ACTH as the underlying cause of her condition?
Options:
A)Productive Cough
B)Hyperpigmentation
C)Central obesity
D)Hypertension
E)Bowel habit change
Would productive cough be a symptom related to excess cortisol ?!
And what does it mean by ectopic ACTH ?!
Does it mean ACTH secreted by another source other than pituitary gland ?!
And if so, couldn't it be related to ectopic ACTH secreted by lung cancer which could be manifested by productive cough ?!
Would productive cough be a symptom related to excess cortisol ?!
And what does it mean by ectopic ACTH ?!
Does it mean ACTH secreted by another source other than pituitary gland ?!
And if so, couldn't it be related to ectopic ACTH secreted by lung cancer which could be manifested by productive cough ?!
I think the question is essentially asking us to differentiate between Cushing's syndrome and Cushing's disease. All the other features mentioned are due to cortisol.
Hyperpigmentation occurs due to melanin, which is a byproduct of the breakdown of POMC (the precursor for ACTH, Beta endorphoins and Melanocortin).
Thus it is the only symptom among those listed, that suggests the symptoms are due to excess ACTH, rather than excess cortisol
I think the question is essentially asking us to differentiate between Cushing's syndrome and Cushing's disease. All the other features mentioned are due to cortisol.
Hyperpigmentation occurs due to melanin, which is a byproduct of the breakdown of POMC (the precursor for ACTH, Beta endorphoins and Melanocortin).
Thus it is the only symptom among those listed, that suggests the symptoms are due to excess ACTH, rather than excess cortisol