PAEA Surgery End Of Rotation (EOR) Practice Exam

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An adrenal carcinoma presents with which of the following lab findings?

High ATCH and high cortisol
Low ACTH and high cortisol
High ACTH and low cortisol
Normal ACTH and normal cortisol

The correct answer is: Low ACTH and high cortisol

In the case of adrenal carcinoma, the laboratory findings typically include low levels of adrenocorticotropic hormone (ACTH) in conjunction with elevated cortisol levels. This is due to the autonomous secretion of cortisol by the adrenal tumor, which does not rely on ACTH from the pituitary gland for its stimulation. When the adrenal glands produce excess cortisol from a carcinoma, this leads to feedback inhibition of the pituitary gland, resulting in decreased ACTH production. In essence, the tumor's secretion of cortisol suppresses the release of ACTH, leading to the characteristic finding of low ACTH levels. The resultant high cortisol levels are indicative of hypercortisolism or Cushing's syndrome, which can be a feature of adrenal carcinoma. Understanding this hormonal relationship is crucial for diagnosing conditions associated with adrenal tumors.