Brown Medical School

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Brown Medical School

Bio 351


Systemic Pathology

Organ System Pharmacology

Final Exam
March 24, 2006

Course Leaders
James Hennessey, MD

Elaine Bearer, MD-PhD

Robert Patrick, PhD


A 29 year-old woman with type 1 diabetes and hypothyroidism presents to her endocrinologist with progressive fatigue and weight loss. Her only medications are a brand-name levothyroxine preparation and insulin Aspart via an insulin pump. A recent TSH was within normal limits. Her diabetes is in excellent control as evidenced by her recent hemoglobin A1c of 6.4 % (Nl 4.3-5.8), though she does report an increased frequency of hypoglycemic episodes. Physical exam is notable for a blood pressure of 88/ 56 mmHg and modest hyperpigmentation of the buccal mucosa.
Adrenal insufficiency is suspected.
1. The most useful initial test in this patient would be:
A. Metyrapone test

B. Midnight salivary cortisol

C. Cortrosyn stimulation test

  1. 24 hour urine collection for free cortisol

  2. None of the above

2. The most likely cause of adrenal insufficiency in this patient would be:

A. Autoimmune adrenalitis

B. Tuberculosis

C. Pituitary tumor

  1. Adrenoleukodystrophy

  2. None of the above

3. Treatment would most likely include:
A. Glucocorticoid but not mineralocorticoid

B Mineralocorticoid but not glucocorticoid

C. Both glucocorticoid and mineralocorticoid

D. Neither glucocorticoid nor mineralocorticoid

E. None of the above

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