A 45-year old female had sought medical attention for her recent increase in weight and proximal limb weakness. She was diagnosed with rheumatoid ahritis. 1 week ago has been staed on prednisolone tablets. Physical examamination revealed truncal obesity; BP - 145/90 mm Hg and PR- -90/ mill. High levies of coisol were found in her blood and 24 hour urine sample. A high dose dexamethasone suppression test was performed and the plasma coisol level was suppressed. Serum ACTH level was high. The etiology of this condition can be confirmed by
Most of the signs and symptoms of ACTH-secreting tumors come from having too much coisol (an adrenal steroid hormone). But quite a few diseases can cause the body makes too much coisol, which is called Cushing's syndrome. If you have symptoms suggesting this syndrome, you'll need tests to see if it's caused by a pituitary tumor or something else. One of the tests used measures the levels of coisol in your saliva late at night to see if they stay elevated. (They normally drop at night.) Another may include measuring levels of coisol and ACTH in blood samples taken at different times of the day. You also may be asked to collect all of your urine over a 24-hour period, which is then tested to measure your daily production of coisol and other steroid hormones. One test involves taking a dose of a powerful, coisone-like drug called dexamethasone, then checking blood or urine coisol levels. Often more than 1 of these tests is needed to help distinguish ACTH-secreting pituitary tumors from other diseases, such as adrenal gland tumors, that can cause similar symptoms. MRI scans to diagnose and monitor head injuries and to check for abnormalities in the head or brain. Magnetic resonance imaging (MRI) scans provide 3-D images of specific body pas. The scan produces highly detailed images from every angle to rule out various carcinomas such as endocrine cancers,brain tumors haemorrages Ref Davidson 23rd edition pg 678
CT scan of the chest
MRI of the brain
CT scan of the abdomen
Plasma metanephrine level
Immune system