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Wow! You are sooooooo tired. Now you have a 25-year-old woman is undergoing a diagnostic work-up because she looks to have Cushing syndrome. She has an elevated level of cortisol, which are not suppressed when she is given high-dose dexamethasone. ACTH levels are greater than 350 pg/ mL. A plain film shows a central, 7-cm round mass on the hilum of the right lung. Bronchoscopy and biopsies confirm a diagnosis of small cell carcinoma of the lung. What drug will you give or what will you do? (Tricky…but this is a typical “throw the focus off-style” question. 1-Remove BOTH adrenals 2-Reassurance, return visit in one month 3-Inject Cortisol to suppress blood levels of ACTH 4-Remove a portion of the pituitary that secrete ACTH 5-Chemotherapy for Lung Carcinoma 6-Minimally Invasive Surgery (removing a lung lobe) of the carcinoma

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Subject: Tommy's Concepts

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Wow! You are sooooooo tired. Now you have a 25-year-old woman is undergoing a diagnostic work-up because she looks to have Cushing syndrome. She has an elevated level of cortisol, which are not suppressed when she is given high-dose dexamethasone. ACTH levels are greater than 350 pg/ mL. A plain film shows a central, 7-cm round mass on the hilum of the right lung. Bronchoscopy and biopsies confirm a diagnosis of small cell carcinoma of the lung. What drug will you give or what will you do? (Tricky…but this is a typical “throw the focus off-style” question.

1-Remove BOTH adrenals
2-Reassurance, return visit in one month
3-Inject Cortisol to suppress blood levels of ACTH
4-Remove a portion of the pituitary that secrete ACTH
5-Chemotherapy for Lung Carcinoma
6-Minimally Invasive Surgery (removing a lung lobe) of the carcinoma

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