endocrine quiz for 9th Jan 2023 Question Title * 1. A 26-year old has a unilateral adrenalectomy for adrenal Cushing's syndrome. She is discharged on prednisolone 3mg daily and stays on this dose for over a year because of lockdown, with no other tests. A synacthen test is undertaken after lockdown on a morning when the patient does not take her prednisolone. Her baseline ACTH is 40 ng/l and cortisol is 59nM, 30 minute cortisol 76nM and a 60 minute cortisol of 81nM. She says that she is generally well and at work, but tired some of the time. What would you advise? switch to hydrocortisone 10mg on waking + 5mg at noon + 5mg at 4pm reduce the current dose of prednisolone to 2.5mg daily continue the current dose of prednisolone at 3mg daily increase the dose of prednisolone to 4mg daily Question Title * 2. An obese patient is referred to exclude Cushing's syndrome from the obesity clinic. Her BMI is 45 kg/m2. She can climb stairs slowly and has no stretch marks. Her cortisol after a 48 hour low dose dexamethasone suppression test (LDDST) 61nM. What would you do next? Overnight dexamethasone suppression test (ONDST) High dose dexamethasone suppression test (HDDST) MRI pituitary (MRI pit) Inferior pituitary sinus sampling (IPSS) Late night salivary cortisol (LNSC) Question Title * 3. What is the purpose of IPSS? Question Title 4. The next three patients have several clinical features of Cushing's syndrome, including proximal myopathy and stretch marks. The cortisol after an overnight dexamethasone suppression test in each case is 400nM. Question Title * 4. How do you interpret the results above? Question Title Question Title * 5. How do you interpret the results above? Question Title Question Title * 6. How do you interpret the results above?The answers will be explained on 9th January 2023. Question Title * 7. what is your e-mail address for the answers that will follow after 9th Jan? Done