Question

Practical Application #1 Use this case report to answer the following multiple choice questions.
Hypertension, both systolic and diastolic, is a common feature of Cushing syndrome. Other clinical features are likely to attract more attention than the hypertension: obesity with “buffalo hump” and “moon face,” muscular weakness, scattered bruises, and osteoporosis. The excessive secretion of adrenocortical steroids that is responsible for the syndrome is frequently due to primary disease of the adrenals, either hyperplasia or discrete tumors. However, the hyperactivity of the adrenal cortex may be secondary to a tumor or malfunction of the pituitary or a neoplasm secreting an ACTH-like substance elsewhere in the body. Appropriate x-ray studies, including arteriograms or retrograde venograms of the adrenals, may disclose a tumor in the adrenals, hypophysis, or elsewhere.

Questions:

Which is a common clinical feature of Cushing syndrome?

		Decreased blood flow to the heart
		Abnormal sounds in the heart
		Peripheral edema
		High blood pressure when the heart is contracting and relaxing Question 2 Cushing syndrome is associated with which of the following? Tendency to accumulate fat in tissues Tetany Bone tumors Low blood pressure Question 3 What is a probable etiology of Cushing syndrome? Excessive porosity of bones Decreased secretion of adrenal hormones Decreased secretion of pituitary hormones Tumor or disease of the adrenal cortex Question 4 What is a likely secondary cause of Cushing syndrome? Deceased secretion of ACTH Blocked artery in the kidney Tumor of the adenohypophysis Muscular weakness

Answer 1

1. The common clinical feature of Cushing syndrome is high blood pressure when the heart is contracting and relaxing. Blood pressure is increased due to truncal obesity.

2. Cushing syndrome is associated with tetany. In Cushing disease calcium level is low. Hypocalcemia will results in tetany.

3. Probable etiology of Cushing syndrome is tumor or disease of the adrenal cortex. Tumor of the adrenal cortex leads to excessive secretion of adrenal hormones resulting in Cushing syndrome.

4. Secondary cause of Cushing syndrome is tumor of the adenohypophysis. Tumor of anterior pituitary ie adenohypophysis, leads to increased secretion of adrenal hormones.