Cortisol And ACTH Measurements Patient 1 has Low cotisol and Low ACTH Patient 2
ID: 3507765 • Letter: C
Question
Cortisol And ACTH Measurements
Patient 1 has Low cotisol and Low ACTH
Patient 2 has High cotisol and Low ACTH
Patient 3 has High cotisol and High ACTH
Patient 4 has Low cotisol and High ACTH
Patient 5 has High cotisol and Low ACTH
Diagonisis
Patient 1- has secondary adrenal insufficiency(hypopituitarism)
patient 2 -hasCushing's syndrome (primary hypercortisolism)
patient 3- has Cushing's disease (secondary hypercortisolism)
Patient 4 -has Addison's disease (primary adrenal insufficiency)
patient 5 -hasCushing's syndrome (primary hypercortisolism)
Question: After analysing the cortisol and ACTH measurements and determing diagnoses, you are told that one of the patients has been taking prednisone for an extended time for treatment of rheumatoid arthritis.You know that prednisone is a synthetic glucocorticoid.
Identify the patients that show results that would be consistent with prednisone treatment.
Explanation / Answer
The correct answer is Patient 1. Treatment with prednisone for long term (even in low dose) causes the adrenal suppression and thus decreases level of cortisol which occurs due to the decreased level of ACTH. ACTH (adrenocorticotrophine) hormone is released from putitary gland which act on adrenal gland and stimulate it to release cortisol. Thus decreased level of ACTH results in decreased level of cortisol.