You suspect Cushing's disease in a 50yo woman who has attended
clinic with glycosuria, HTN and a suggestive body habitus. Initial inv
point you towards a dx of Cushing's disease. Which of the following
findings would be against this dx?
a. A normal 8am cortisol
b. Failure to suppress morning cortisol with dexamethasone
c. HTN requiring >2 antihypertensive agents
d. Impaired growth hormone response to glucose loading
e. Unilateral adrenal enlargement
answer:E
Cushing's disease (pituitary adenoma) cause bilateral hyperplasia
A normal 8am cortisol would be unusual but won't rule out cushings because there is diurnal variation in cortisol release, a 24hr urinary cortisol is specific.
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