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NBME 20 Answers

nbme20/Block 4/Question#9

A previously healthy 37-year-old woman comes to the ...

Tumor of the adrenal zona fasciculata

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Pt has signs and Sx of hypercortisol. Low/normal ACTH favors elevated cortisol independent of ACTH, confirmed by lack of response to dexamethasone suppression. Zona fasciculata is origin of cortisol production.

champagnesupernova3  They tried to confuse us saying both low dose and high dose dexamethasone didnt suppress it. But when ACTH is low you dont even need to do high dose dexamethasone test. The high dose is only to differentiate between Pituitary adenoma and ectopic ACTH production +  

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submitted by dickass(16),

Remember kids, GFR corresponds with Salt (mineralocorticoids), Sugar (glucocorticoids), and Sex (androgens).