Cushing's Syndrome Guideline Quiz

Which of the following medications can rapidly lower cortisol levels in patients with severe hypercortisolism?

a) Ketoconazole
b) Metyrapone
c) Etomidate
d) All of the above

Which of the following is a life-threatening complication of CS that requires urgent treatment?

a) Increased BMD
b) Acne
c) Infection
d) Impaired cognitive function

A 35-year-old female is diagnosed with ectopic ACTH syndrome associated with serious comorbidities including pulmonary thromboembolism and cardiovascular problems. What is the recommended management for severe hypercortisolism in this patient?

a. Bed rest and observation
b. Initiation of ketoconazole and metyrapone combination therapy
c. Bilateral adrenalectomy
d. Observation and referral for elective surgery

Which medications target SST2 and Dopamine 2 receptors, and may reduce ACTH secretion to control hypercortisolism in ectopic ACTH-secreting tumors?

A. Mifepristone and Mitotane
B. Vandetanib and Sorafenib
C. Cabergoline and Octreotide
D. Pasireotide and Ketoconazole

Which medication is the only medical treatment available for severe hypercortisolism in seriously ill patients who cannot take oral medications, and is useful in an emergency setting with acute unmanageable symptoms such as respiratory failure or severe psychosis?

A. Mitotane
B. Cabergoline
C. Mifepristone
D. Etomidate

What is the primary use of Mitotane in Cushings syndrome?

A. To control hypertension and/or diabetes
B. To treat ectopic ACTH production
C. To treat adrenal carcinoma
D. To inhibit ACTH production in corticotroph tumors

Which of the following medications is a dopamine agonist with high affinity for dopamine receptor subtype 2, and is effective in treating corticotroph adenomas?

A. Mifepristone
B. Pasireotide
C. Mitotane
D. Cabergoline

A 55-year-old female with Cushing’s disease is not a surgical candidate due to severe comorbidities. Which of the following medications can be used to treat her hypercortisolism?

a. Cabergoline
b. Etomidate
c. Mitotane
d. Pasireotide

A 42-year-old male presents with Cushing’s disease, and his UFC levels have not normalized after transsphenoidal surgery. Which of the following medications can be used to treat his hypercortisolism?

a. Cabergoline
b. Etomidate
c. Mitotane
d. Pasireotide

A 34-year-old female presents with Cushing’s syndrome due to an adrenal adenoma. She is noted to be hypertensive and febrile. She is admitted to the ICU and is not deemed a surgical candidate at this time due to her multiple comorbidities. Which of the following medications can be used to treat her severe hypercortisolism?

a. Cabergoline
b. Etomidate
c. Mitotane
d. Pasireotide

A 30-year-old female with Cushing’s syndrome is started on mitotane therapy. What adverse effect should be monitored for?

a. Hepatic dysfunction
b. Gastrointestinal disturbances
c. Endometrial thickening
d. Hypertension and hypokalemia

A 55-year-old male with Cushing’s syndrome has glucose intolerance and hypertension that has not improved with surgery. What medication would be most appropriate for medical management?

a. Ketoconazole
b. Metyrapone
c. Mitotane
d. Mifepristone

A 35-year-old female with Cushing’s disease undergoes transsphenoidal surgery but has persistent hypercortisolism. What is the next line of treatment?

a. Ketoconazole
b. Metyrapone
c. Mitotane
d. Mifepristone

A 55-year-old female with Cushing’s disease who underwent TSS and had persistent disease. She is not a surgical candidate. She has diabetes and glucose intolerance. Which medication would you suggest?

a. Pasireotide
b. Mitotane
c. Metyrapone
d. Mifepristone

A 45-year-old male with ectopic ACTH syndrome who is unresponsive to surgical treatment. Which medication would you suggest?

a. Pasireotide
b. Cabergoline
c. Mitotane
d. Ketoconazole

A 35-year-old female with Cushing’s disease who underwent transsphenoidal surgery (TSS) and had persistent disease. She is not a surgical candidate. Which medication would you suggest?

a. Pasireotide
b. Mitotane
c. Metyrapone
d. Cabergoline

A 58-year-old man with ACTH-dependent Cushing’s syndrome has undergone transsphenoidal surgery but has persistent disease. Which of the following therapies would be appropriate?

a. Etomidate
b. Mitotane
c. Pasireotide
d. Repeat transsphenoidal surgery

A 62-year-old woman with ACTH-dependent Cushing’s syndrome and diabetes is not a surgical candidate. Which of the following medications would be the most appropriate for her?

a. Cabergoline
b. Ketoconazole
c. Metyrapone
d. Mifepristone

A 36-year-old man with Cushing’s disease has failed transsphenoidal surgery and radiation therapy. What is the appropriate next step in his management?

a. Mitotane
b. Etomidate
c. Ketoconazole
d. Pasireotide

A 47-year-old woman with newly diagnosed ACTH-dependent Cushing’s syndrome is not a candidate for surgery. What is the appropriate first-line medical therapy for her?

a. Ketoconazole
b. Cabergoline
c. Metyrapone
d. Pasireotide

A 35-year-old male with Cushing’s disease undergoes bilateral adrenalectomy. What is the appropriate next step in management?

A. Repeat transsphenoidal surgery
B. Radiotherapy
C. Medical therapy
D. Regular evaluation for corticotrope tumor progression using pituitary MRIs and ACTH levels

A 55-year-old male with very severe ACTH-dependent Cushing’s syndrome cannot be promptly controlled by medical therapy. What is the most appropriate next step in management?

A. Repeat transsphenoidal surgery
B. Radiotherapy
C. Medical therapy
D. Bilateral adrenalectomy

A 45-year-old female presents with persistent Cushing’s syndrome after noncurative transsphenoidal surgery. What is the most appropriate next step in management?

A. Repeat transsphenoidal surgery
B. Radiotherapy
C. Medical therapy
D. Bilateral adrenalectomy

Which of the following is true regarding the discontinuation of glucocorticoid replacement after surgical remission of ACTH-producing tumors?

A) Glucocorticoid replacement should be discontinued immediately after surgery.
B) Glucocorticoid replacement should be discontinued when the patient is symptom-free.
C) Glucocorticoid replacement should be discontinued when cortisol levels are undetectable.
D) Glucocorticoid replacement should be discontinued when the response to morning cortisol and/or ACTH stimulation tests is normal.

Which of the following is true regarding glucocorticoid replacement after surgical remission of ACTH-producing tumors?

A) Glucocorticoid replacement is not required after successful surgery.
B) Patients do not experience glucocorticoid withdrawal after successful surgery.
C) Glucocorticoid replacement should be given until the HPA axis has recovered.
D) Glucocorticoid replacement should be discontinued immediately after surgery.

What is the recommended approach for measuring cortisol levels in patients with eucortisolism after transsphenoidal surgery for Cushing’s disease?

A. Late-night serum cortisol should be measured.
B. Late-night salivary cortisol should be measured.
C. Both late-night serum and salivary cortisol should be measured.
D. None of the above.

What is the recommended approach for patients with persistent overt hypercortisolism after surgical resection of an ACTH-producing tumor?

A. No additional treatment is recommended.
B. Adjuvant radiotherapy is recommended.
C. Adjuvant medical therapy is recommended.
D. Bilateral adrenalectomy is recommended.

A 35-year-old patient with Cushing’s disease undergoes selective tumor resection. What is the definition of remission, and what is the remission rate for microadenomas and macroadenomas, respectively?

A. Remission is defined as postoperative morning serum cortisol values <5 μg/dL or UFC <28–56 nmol/d within 14 days of selective tumor resection. Remission rate for microadenomas is 73-76%, and for macroadenomas, it is ∼43%.
B. Remission is defined as postoperative morning serum cortisol values <5 μg/dL or UFC <28–56 nmol/d within 7 days of selective tumor resection. Remission rate for microadenomas is 73-76%, and for macroadenomas, it is ∼43%.
C. Remission is defined as postoperative morning serum cortisol values <10 μg/dL or UFC <56 nmol/d within 14 days of selective tumor resection. Remission rate for microadenomas is 80-85%, and for macroadenomas, it is ∼50%.
D. Remission is defined as postoperative morning serum cortisol values <10 μg/dL or UFC <56 nmol/d within 7 days of selective tumor resection. Remission rate for microadenomas is 80-85%, and for macroadenomas, it is ∼50%.

What is the optimal treatment for bilateral macronodular adrenal hyperplasia (BMAH) with aberrant hormone receptors?

A. Bilateral adrenalectomy
B. Medical therapy with glucocorticoid receptor antagonists
C. Observation
D. Unilateral adrenalectomy

What is the definitive treatment of choice for primary pigmented nodular adrenal disease in most cases?

A. Medical therapy
B. Unilateral adrenalectomy
C. Bilateral adrenalectomy
D. Radiation therapy

What is the optimal treatment for a patient with ectopic ACTH-secreting tumor and no overt metastatic disease?

A. Radiation therapy
B. Adjuvant chemotherapy
C. Observation
D. Ectopic ACTH-producing tumor resection

What is the first-line treatment for a patient with a unilateral cortisol-producing adrenal adenoma?

A. Transperitoneal laparoscopic adrenalectomy
B. Open adrenalectomy
C. Medical treatment of comorbidities
D. Inferior petrosal sinus sampling

A 50-year-old female presents with a history of recurrent infections and weight gain. Laboratory testing shows elevated cortisol levels and low ACTH levels. Imaging studies are negative for a pituitary adenoma or adrenal mass. What is the first-line treatment for this patient?

A. Medical treatment to reduce cortisol levels
B. Radiation therapy
C. Ectopic ACTH-secreting tumor resection
D. Observation

A 40-year-old male presents with uncontrolled hypertension, hypokalemia, and elevated cortisol levels. Imaging studies reveal a unilateral adrenal adenoma. What is the first-line treatment for this patient?

A. Medical treatment to reduce cortisol levels
B. Observation
C. Unilateral adrenalectomy by an experienced adrenal surgeon
D. Radiation therapy

A 35-year-old female presents with weight gain, muscle weakness, easy bruising, and irregular menses. Physical examination reveals central obesity, moon face, and ecchymoses. Laboratory testing shows elevated cortisol levels and low ACTH levels. What is the first-line treatment for this patient?

A. Medical treatment to reduce cortisol levels
B. Radiation therapy
C. Transsphenoidal surgery
D. Observation

What is the recommended approach to managing comorbidities in patients with Cushing’s syndrome?

A) Addressing only cortisol-dependent comorbidities
B) Treating comorbidities after remission is achieved
C) Providing education to patients and their family/caretakers about their disease and what to expect after remission
D) Monitoring and adjunctive treatment for cortisol-dependent comorbidities and seeking appropriate consultations

What is the recommended approach to treating patients with mild or cyclic hypercortisolism?

A) Immediate treatment to normalize cortisol levels or action
B) Monitoring over time to establish a clinical diagnosis
C) Administering treatment in life-threatening situations, regardless of biochemical data
D) Administering treatment if values are less than 1.5-fold upper reference range

A 40-year-old female patient is diagnosed with Cushing’s syndrome. What is the primary goal of treating her hypercortisolism?

A) To achieve a reduction in cortisol levels or action, regardless of signs and symptoms
B) To achieve remission and eliminate the signs, symptoms, and comorbidities associated with hypercortisolism
C) To improve quality of life by addressing only the comorbidities associated with hypercortisolism
D) To achieve normal cortisol levels, even if signs and symptoms persist

A 28-year-old female presents with a history of weight gain, irregular menstrual periods, and acne. Physical examination reveals facial hirsutism and abdominal striae. Laboratory tests show a high serum cortisol level and a lack of diurnal variation. What is the appropriate initial step in management?

A. Start glucocorticoid therapy
B. Start metyrapone therapy
C. Refer for adrenalectomy
D. Perform a dexamethasone suppression test

A 45-year-old male presents with a history of hypertension, weight gain, and easy bruising. Physical examination reveals a buffalo hump, moon facies, and acne on his face and chest. Laboratory tests show a high serum cortisol level and a lack of diurnal variation. What is the appropriate next step in management?

A. Start glucocorticoid therapy
B. Start metyrapone therapy
C. Refer for adrenalectomy
D. Perform imaging studies of the adrenal glands

Management of Cushing’s Syndrome

Cushing’s Syndrome Guideline Quiz

Cushing’s Syndrome Guideline Quiz

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