Cushing’s Syndrome Endocrine Society Guideline Practice Quiz

Practice Test (Cushing’s Syndrome)

Are you looking to test your knowledge on the diagnosis of Cushing’s Syndrome? Look no further than The Diagnosis of Cushing’s Syndrome: An Endocrine Society Clinical Practice Guideline quiz! This quiz is based on the latest information and recommendations from the Endocrine Society, ensuring that you are up-to-date on the latest practices and guidelines in the field

Cushings syndrome Endocrine Society

Updates

1. Which of the following is recommended by the Endocrine Society as the first step in testing for Cushing's syndrome?

a) Obtaining a thorough drug history

b) Conducting a nonsuppressed cortisol measurement

c) Performing a UFC test

d) Administering a 1-mg overnight DST

e) Conducting a late-night salivary cortisol test

2. Which patient group is recommended for testing for Cushing's syndrome?

a) Patients with a history of autoimmune disease

b) Patients with a history of respiratory disease

c) Patients with multiple and progressive features

d) Patients with a history of cardiovascular disease

e) Patients with a history of cancer

3. What are the recommended initial tests for Cushing's syndrome?

a) UFC and late-night salivary cortisol

b) 1-mg overnight DST and longer low-dose DST

c) UFC and 1-mg overnight DST

d) Late-night salivary cortisol and longer low-dose DST

e) UFC, late-night salivary cortisol, and 1-mg overnight DST

4. What is the purpose of the 1-mg overnight DST in the initial testing of Cushing's syndrome?

a) To measure nonsuppressed cortisol in blood, saliva, or urine

b) To identify patients with severe renal failure

c) To diagnose cyclic Cushing's syndrome

d) To diagnose mild Cushing's syndrome in patients with an adrenal incidentaloma

e) To identify patients with unusual features for age

5. Which of the following tests is recommended for children with decreasing height percentile and increasing weight?

a) UFC

b) Late-night salivary cortisol

c) Nonsuppressed cortisol measurement

d) 1-mg overnight DST

e) None of the above

6. What is the recommended method of testing for Cushing's syndrome in patients suspected of having cyclic Cushing's syndrome?

a) UFC

b) Late-night salivary cortisol

c) Nonsuppressed cortisol measurement

d) 1-mg overnight DST

e) Longer low-dose DST (2 mg/d for 48 h)

7. What is the main cause of mortality in individuals with severe hypercortisolism, according to early reports?

a) Vascular and infectious complications

b) Respiratory failure

c) Gastrointestinal bleeding

d) Renal failure

e) Neurological complications

8. What is the standard mortality ratio (SMR) after successful normalization of cortisol?

a) Higher than that of an age-matched population

b) Similar to that of an age-matched population

c) Lower than that of an age-matched population

d) The SMR cannot be accurately determined

e) None of the above

9. What are the potential consequences of successful treatment of hypercortisolism in Cushing's syndrome?

a) Complete normalization of features of Cushing's syndrome

b) Improved bone mineral density and cognitive function

c) Improved quality of life

d) Decreased risk of infection

e) All of the above

10. What are the diagnostic criteria that suggest Cushing's syndrome?

a. Serum cortisol greater than 1.8 μg/dl (50 nmol/liter) after 1 mg dexamethasone (1-mg DST)

b. Late-night salivary cortisol greater than 145 ng/dl (4 nmol/liter)

c. UFC greater than the normal range for the assay

d. A and B only

e. A, B, and C

11. What is the Endocrine Society's recommendation regarding the use of random serum cortisol or plasma ACTH levels for testing Cushing's syndrome?

a. It is recommended for the initial testing for Cushing's syndrome

b. It is recommended for the subsequent evaluation of abnormal initial test results

c. It is recommended against the use of this test to test for Cushing's syndrome

d. It is suggested as an additional test in specific situations

e. It is recommended for patients suspected of having cyclical disease

12. What is the Endocrine Society's suggestion for the evaluation of individuals with normal test results in whom the pretest probability is high for Cushing's syndrome?

a. Further evaluation is not necessary

b. Reevaluation in 6 months is recommended

c. Further evaluation by an endocrinologist is recommended to confirm or exclude the diagnosis

d. The use of the dexamethasone-CRH test or the midnight serum cortisol test is suggested

e. The use of the desmopressin test is recommended

13. In what situation does the Endocrine Society recommend the use of the 1-mg overnight DST rather than UFC for initial testing for Cushing's syndrome?

a. Patients suspected of having cyclical Cushing's syndrome

b. Patients suspected of having mild Cushing's syndrome

c. Patients with severe renal failure

d. Pregnant women

e. Patients receiving antiepileptic drugs known to enhance dexamethasone clearance

14. What is the Endocrine Society's recommendation for the use of dexamethasone testing in the initial evaluation of pregnant women?

a. It is recommended

b. It is suggested as an additional test in specific situations

c. It is recommended against the use of this test in the initial evaluation of pregnant women

d. It is recommended for patients suspected of having cyclical disease

e. It is recommended for the subsequent evaluation of abnormal initial test results

15. What test should be used in the initial evaluation of pregnant women suspected of having Cushing's syndrome?

a) UFC

b) Dexamethasone testing

c) Random serum cortisol

d) Midnight salivary cortisol test

16. What should be done for patients with normal test results in whom the pretest probability is high?

a) No further evaluation is needed

b) Further evaluation is suggested in 6 months if signs or symptoms progress

c) Further evaluation by an endocrinologist is recommended to confirm or exclude the diagnosis

d) Additional tests should be conducted, such as the desmopressin test

17. What are the diagnostic criteria that suggest Cushing's syndrome?

a) UFC, serum cortisol, and midnight salivary cortisol all within normal ranges

b) UFC greater than the normal range, serum cortisol greater than 1.8 μg/dl after 1 mg dexamethasone, and late-night salivary cortisol greater than 145 ng/dl

c) Plasma ACTH levels greater than the normal range, urinary 17-ketosteroids, and insulin tolerance test

d) Random serum cortisol, Loperamide test, and pituitary and adrenal imaging

18. What is the most common cause of Cushing's syndrome?

A) Excess ACTH secretion

B) Independent adrenal overproduction of cortisol

C) Mild hypercortisolism

D) Medically prescribed corticosteroids

19. What are some features of Cushing's syndrome that are more discriminatory than others?

A) Obesity, depression, diabetes, hypertension, or menstrual irregularity

B) Reddish purple striae, plethora, proximal muscle weakness, bruising with no obvious trauma, and unexplained osteoporosis

C) Physical stress, malnutrition, anorexia nervosa, intense chronic exercise, and hypothalamic amenorrhea

D) None of the above

20. What is the rationale for early recognition and treatment of mild Cushing's syndrome?

A) It is likely to reduce the risk of residual morbidity.

B) It leads to a normalization of features of Cushing's syndrome.

C) It improves cognitive dysfunction in all patients.

D) It leads to a final stature within the predicted parental target range in all patients.

21. What is the likely cause of mild hypercortisolism associated with certain psychiatric disorders, poorly controlled diabetes mellitus, and alcoholism?

A) Overactivity of the hypothalamic-pituitary-adrenal (HPA) axis

B) Independent adrenal overproduction of cortisol

C) Excess ACTH secretion

D) None of the above

22. What do the recommendations for testing for Cushing's syndrome in these guidelines primarily rely on?

A) Direct evidence from observational studies indicating a large treatment effect

B) Indirect evidence from studies that yield data on the accuracy of currently available tests

C) Both direct and indirect evidence

D) None of the above

23. Which of the following is the most common cause of Cushing's syndrome?

a. Iatrogenic from medically prescribed corticosteroids

b. Excess ACTH secretion from a pituitary tumor

c. Excess cortisol production from an adrenal tumor

d. Excess cortisol production from other ectopic tumors

24. Which of the following is NOT a discriminatory feature of Cushing's syndrome?

a. Facial Plethora

b. Reddish purple striae

c. Proximal muscle weakness

d. Mild hypertension

25. What is the sensitivity of combined reduced linear growth and increased weight in children for the diagnosis of Cushing's syndrome?

a. Low

b. Moderate

c. High

d. Very high

26. Which of the following is the most appropriate initial test for the diagnosis of Cushing's syndrome?

a. Random serum cortisol

b. Urinary 17-ketosteroids

c. Late-night salivary cortisol

d. Insulin tolerance test

27. What is the recommended approach to individuals with normal test results but a high pretest probability of Cushing's syndrome?

a. Reevaluation in 6 months

b. Further evaluation by an endocrinologist

c. Repeat the same test

d. No further evaluation needed

28. Which of the following drugs accelerates dexamethasone metabolism by induction of CYP 3A4?

a. Estrogens

b. Itraconazole

c. Rifampin

d. Licorice

29. What is the recommended time frame for withdrawing estrogen-containing drugs before testing or retesting for Cushing's syndrome?

a. 2 weeks

b. 4 weeks

c. 6 weeks

d. 8 weeks

30. What is the advantage of obtaining at least two measurements of urine or salivary cortisol for the diagnosis of Cushing's syndrome?

a. It allows for evaluation of false-positive and negative responses.

b. It eliminates the need for simultaneous measurement of cortisol and dexamethasone.

c. It ensures adequate plasma dexamethasone concentrations.

d. It reduces interindividual variation in dexamethasone clearance.

31. Which of the following drugs inhibits dexamethasone metabolism by inhibition of CYP 3A4?

a. Carbamazepine

b. Ritonavir

c. Mitotane

d. Phenytoin

32. What does UFC measure in the evaluation of cortisol secretion?

a. Total cortisol

b. CBG-bound cortisol

c. Unbound cortisol

d. Metabolites of cortisol

33. Which of the following drugs increases CBG and may falsely elevate cortisol results?

a. Rifampin

b. Carbamazepine

c. Estrogens

d. Aprepitant

34. What is the first morning void?

a. The first urine collection of the day

b. The last urine collection of the day

c. The urine collection on the second morning

d. The urine collection after drinking excessive amounts of fluids

35. What should patients avoid during the UFC collection?

a. Drinking excessive amounts of fluids

b. Eating salty foods

c. Consuming caffeine

d. Using steroid-containing creams

36. When is the best time to collect a late-night salivary cortisol sample?

a. At midnight

b. Between 0800 and 0900 h

c. Between 2300 and 2400 h

d. In the morning after waking up

37. What is the best technique for collecting saliva for late-night salivary cortisol testing?

a. Active spitting into a plastic tube

b. Passive drooling into a plastic tube

c. Using a cotton pledget (salivette)

d. Swallowing a pill

38. Which medical condition may cause overactivation of the HPA axis without true Cushing's syndrome?

a. Hypothyroidism

b. Diabetes mellitus

c. Osteoporosis

d. Rheumatoid arthritis

39. What is the cutoff value for suppression of serum cortisol in the 1-mg overnight dexamethasone suppression test?

a. 3.6-7.2 μg/dl

b. 1.8 μg/dl

c. 5 μg/dl

d. 100-200 nmol/liter

40. What is the recommended dexamethasone dose for the 48-h low-dose dexamethasone suppression test?

a. 1 mg

b. 2 mg

c. 3 mg

d. 4 mg

41. What is the recommended length of abstinence from alcohol before performing the 48-h, 2 mg/d low-dose dexamethasone suppression test?

a. 24 hours

b. 48 hours

c. 1 week

d. 2 weeks

42. How many collections of 24-h urine should be performed for the UFC test?

a. One

b. Two

c. Three

d. Four

43. At what time should saliva samples be collected for the late-night salivary cortisol test?

a. Between 0600 and 0700 h

b. Between 1700 and 1800 h

c. Between 2300 and 2400 h

d. Between 0800 and 0900 h

44. What is the most validated assay used in the United States to measure salivary cortisol?

a. ELISA

b. RIA

c. ECLIA

d. CLIA

45. What is the cutoff value for the suppression of serum cortisol in the 1-mg dexamethasone suppression test?

a. Less than 3.6 μg/dl

b. Less than 5 μg/dl

c. Less than 7.2 μg/dl

d. Less than 1.8 μg/dl

46. What is the recommended duration of abstinence from alcohol before performing the 48-h, 2 mg/d low-dose dexamethasone suppression test?

a. 1 week

b. 2 weeks

c. 3 weeks

d. 4 weeks

47. What is the diagnostic accuracy of the 48-h, 2 mg/d low-dose dexamethasone suppression test in adults without Cushing's syndrome?

a. 50%

b. 70%

c. 80%

d. 90%

48. Which of the following tests is recommended for retesting patients with initially normal test results who develop new or progressive signs or symptoms of Cushing's syndrome?

a. Loperamide test

b. Insulin tolerance test

c. 8 mg dexamethasone suppression test

d. Urinary 17-ketosteroids

49. Why is the diagnostic accuracy of tests previously advocated for the diagnosis of Cushing's syndrome considered too low to recommend them for testing?

a. They are too expensive

b. They are difficult to perform

c. They are not reliable

d. They have insufficient evidence for their diagnostic accuracy

50. Why is referral to endocrinology centers with expertise and interest in Cushing's syndrome recommended for patients with abnormal initial testing?

a. It is cheaper than other options

b. It is easier to perform

c. It is likely to be associated with better patient outcomes

d. It is faster than other options

51. Which of the following tests is recommended for subsequent evaluation of abnormal test results from one of the high-sensitivity tests?

a. Desmopressin test

b. Dexamethasone-CRH test

c. Insulin tolerance test

d. Loperamide test

52. What is the basis of the midnight serum cortisol test?

a. The response to CRH administration

b. The loss of nocturnal nadir of serum cortisol values