內科專科醫生題庫下載題庫

1. High dose dexamethasone suppression test可用來鑑別診斷pituitary或是Ectopic ACTH production但病人已接受過pituitary surgery，因此不需做此檢查

For ACTH-dependent cortisol excess, a magnetic resonance image (MRI) of the pituitary is the investigation of choice 

1. 同上，已做過pituitary surgery，不需要再追蹤brain MRI

2. inferior petrosal sinus sampling，可用在High dose DEX結果equivocal時來鑑別診斷pituitary或是Ectopic ACTH production但病人已接受過pituitary surgery，因此不需做此檢查

bilateral inferior petrosal sinus sampling (IPSS) with con- current blood sampling for ACTH in the right and left inferior petrosal sinus and a peripheral vein. An increased central/peripheral plasma ACTH ratio >2 at baseline and >3 at 2–5 min after CRH injection is indicative of Cushing’s disease, with very high sensitivity and specificity 

1. 病人為ACTH-dependent Cushing’s  syndrome，當pituitary 不像病灶時，應安排胸腹骨盆腔電腦斷層查Ectopic ACTH

If the differential diagnostic testing indicates ectopic ACTH syndrome, then further imaging should include high-resolution, fine-cut CT scanning of the chest and abdomen for scrutiny of the lung, thymus, and pancreas. If no lesions are identified, an MRI of the chest can be considered because carcinoid tumors usually show high signal intensity on T2-weighted images 

1. Cushing’s syndrome首選治療為手術治療，因此藥物治療在診斷確立前應無角色