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A 22 year old female with clinical suspicion for hypercortisolism is seen by the endocrinologist for follow

up after obtaining laboratory work. In addition to her Cushinoid features, all of the lab results are consistent

with hypercortisolism. She is now in your office to discuss the results and the next step in

management. Her laboratory results are as follows.:

Adrenocorticotropic hormone: low

Urine free cortisol: ElevatedCortisol (8 AM)

After 1 mg of dexamethasone the night before: Elevated

After 8 mg of dexamethasone the night before: Elevated

What test do you order next?

Serum/urine catecholamine

CT scan of the head

CT Scan of the abdomenMRI of the head

Cosyntropin stimulation test

Your answer is correct

This is a patient with suspected hypercortisolism. With low ACTH and cortisol leels that are notsuppressed after hi!h and low dose de"amethasone suppression test# one of the suspicions isthat the patient has an ectopic adrenal nodule that is responsible for the results shown aboe. $nthe contrary# patients who hae pituitary adenomas resultin! in Cushin!s will hae eleated

ACTH# eleated urine free cortisol# and hi!h de"amethasone suppression test will partiallydepress the cortisol leel. Thus# in this patient# one of the areas to ealuate is the adrenal !landby obtainin! CT Scan of the abdomen.

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