A woman was admitted to the hospital with a BP of 156/110 and ahistory of Type 2 diabetes mellitus. She was light headed, her facewas flushed (plethora), and her respiratory rate was slightlyincreased. She reported having menstrual irregularities. Physicalexamination revealed some central obesity (apple shape) and purplestriae. The patient also exhibited some characteristics ofhirsuitism.
The physician ordered an electrolyte profile and all values werenormal. The physician thought this patient may have an endocrineproblem.
1. What condition can be removed from considerationbased on the electrolyte results? Explain your answer.
The physician thought this patient may have an endocrine problemand ordered an ACTH level and serum and 24-hour urine free Cortisollevels.
The ACTH was greater than 25 pg/uL and the urinary cortisol was345 ug/24-hours. The serum cortisol was drawn at 8 am and at 11 pmand the results were above normal for both specimens.
2. Based on the patient’s history and laboratoryresults, what is the most likely clinical diagnosis the physicianshould consider? Explain your rationale.
3. Why are these serum cortisol results significant insupporting a diagnosis of Cushing’s syndrome?
4. What additional laboratory test(s) would help thephysician to confirm the diagnosis? Explain yourrationale.
