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Cushing's syndrome — SCE Endocrinology MCQ

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HardAdrenalCushing's syndromeSCE Endocrinology

A 46-year-old woman has weight gain, proximal myopathy, bruising and hypertension. Overnight 1 mg dexamethasone suppression test shows cortisol 236 nmol/L. ACTH is 24 ng/L. What is the most appropriate next investigation?

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Correct answer: C — Confirm ACTH-dependent Cushing's syndrome with further endocrine testing

Failure to suppress cortisol suggests Cushing's syndrome, and measurable ACTH indicates ACTH-dependent disease requiring confirmatory testing and source localisation. Simple obesity should not explain bruising and proximal myopathy with abnormal suppression. Adrenalectomy without localisation is premature.

Reference: Endocrine Society Cushing's Syndrome Guideline