Chapter Eighteen
PRACTICAL APPLICATIONS
Name: ______________________________
A. Cushing Syndrome
Hypertension, both systolic and diastolic, is a common feature of Cushing syndrome. Other clinical
features are likely to attract more attention than the hypertension: obesity with “buffalo hump” and
“moon face,” muscular weakness, scattered bruises, and osteoporosis. The excessive secretion of
adrenocortical steroids that is responsible for the syndrome is frequently due to primary disease of
the adrenals, either hyperplasia or discrete tumors. However, the hyperactivity of the adrenal cortex
may be secondary to a tumor or malfunction of the pituitary or a neoplasm secreting an ACTH-like
substance elsewhere in the body. Appropriate x-ray studies, including arteriograms or retrograde
venograms of the adrenals, may disclose a tumor in the adrenals, hypophysis, or elsewhere.
1. Which is a common clinical feature
of Cushing syndrome? …………………..
A. Decreased blood flow to the heart
B. Abnormal sounds in the heart
C. Peripheral edema
D. High blood pressure when the heart is
contracting and relaxing
2. Cushing syndrome is associated with
which of the following? …………………..
A. Tendency to accumulate fat in tissues
B. Tetany
C. Bone tumors
D. Low blood pressure
3. What is a probable etiology of
Cushing syndrome? ……………………….
A. Excessive porosity of bones
B. Decreased secretion of adrenal hormones
C. Decreased secretion of pituitary hormones
D. Tumor or disease of the adrenal cortex
4. What is a likely secondary cause of
Cushing syndrome? ……………………….
A. Decreased secretion of ACTH
B. Blocked artery in the kidney
C. Tumor of the adenohypophysis
D. Muscular weakness
B. Chart Note
A 26-year-old woman is referred for Graves disease. The patient was first found to be hyperthyroid
shortly after she became pregnant. She has a tremor in her hands, a sensation of being hot, insomnia,
weakness in her legs, and exophthalmos.
Physical examination reveals thyromegaly; the gland is rather mushy and soft. No nodules were
noted. T3 and T4 levels were ordered and an appointment was made to have an uptake scan.
1. What is the cause of Graves disease? …
A. The thyroid gland is slow to function
B. The pancreas is hyperfunctioning
C. The thyroid gland is oversecreting
D. Hyperactive ovarian function
2. Why were T3 and T4 levels ordered? …..
A. To measure the extent of eyelid prolapse
B. To assess the function of the thyroid gland
C. To measure the size of the thyroid gland
D. To assess heart function