BOF 45

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BOF: 45

A 56-year-old male presents with a history of feeling tired and weak. On examination he is obese and has marked pigmentation of his skin. Blood pressure 190/110. he also has demonstrable weakness of his proximal muscles .

Investigations reveal

Urea 5 mmol/L

Sodium 140 mmol/L

Potassium 2.7 mmol/L

Bicarbonate 32 mmol/L

Glucose 12 mmol /L

In this patient which one of the following would you arrange as the initial investigation?

a)      Adrenal MRI

b)      24 hour urinary free cortisol

c)      High dose dexamethasone suppression test

d)      Plasma ACTH levels

e)      CRH test

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