NBME 18 Adrenocorticotropic hormone stimulation test (NBME Answers)

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Retired NBME 18 Answers

nbme18/Block 2/Question#9 (reveal difficulty score)
19 yo woman being treated for meningococcal ...
Adrenocorticotropic hormone stimulation test 🔍 / 📺 / 🌳 / 📖
tags: endo

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submitted by ∗dorsal_vein(47)

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Administer ACTH and monitor cortisol response
If cortisol increases --> shock is due to pituitary insufficiency
If cortisol does not increase --> shock is due to adrenal insufficiency

Dexamethasone suppression test is indicated for patients who present with signs of cortisol EXCESS.

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+9 upvote downvote
submitted by chai_md(9)

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Neisseria meningitides can lead to Waterhouse-Friderichsen syndrome (adrenal insufficiency, fever, DIC, shock)

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overa if there is ever a case where the organ is underperforming, you do a stimulation test. if the organ is overperforming, you do a suppression test. ACTH is really the only one that made sense with WFS (adrenal insufficiency caused by N. meningitides) in this question. +8

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