Which of the following manifestations is associated with a raised level of cortisone and ACTH?

Appeared in: KPSC Staff Nurse - 2016

Explanation

Elevated levels of cortisone (cortisol) and ACTH indicate hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis, which is strongly linked to mood or affective disturbances.
Depression is the single most common psychiatric manifestation of hypercortisolism (Cushing's syndrome), occurring in up to 75% of patients.
Other common affective symptoms include anxiety, irritability, and emotional lability, which collectively fall under the category of affective disturbances.

Why Other Options Were Wrong

Option A: Confusion is a non-specific symptom. While cognitive deficits are common in hypercortisolism, acute confusion (delirium) is not a typical primary manifestation.
Option C: There is no strong, causal link establishing schizophrenia as a primary manifestation of high cortisol levels. The association is much weaker than with mood disorders.
Option D: This is the name of the underlying diagnosis, not a manifestation (sign or symptom). Cushing's disease is the condition caused by a pituitary tumor overproducing ACTH. The question asks for a manifestation of the resulting high hormone levels.

Related Visual

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Psychiatric manifestations of hypercortisolism (Cushing's syndrome) as background academic context rather than a clinical decision trigger.
Nurses should maintain a high index of suspicion for an underlying endocrine disorder, like Cushing's syndrome, in patients presenting with new-onset or treatment-resistant depression, anxiety, or significant mood lability.
Assessment should include monitoring for both psychiatric symptoms (mood, cognition) and physical signs of hypercortisolism (e.g., central obesity, facial rounding, hypertension, hyperglycemia, skin changes).
What if? If a patient on long-term high-dose steroid medication (iatrogenic Cushing's syndrome) develops these symptoms, the priority nursing action would be to assess the symptoms, document them, and collaborate with the physician to potentially adjust the steroid dosage or manage the psychiatric symptoms, rather than immediately suspecting a pituitary tumor.

How to Approach the Question

First, identify the core of the question: it asks for a 'manifestation' (a sign or symptom) associated with high 'cortisone and ACTH'.
Analyze the options to see which one fits the definition of a manifestation.
Recognize that 'affective disturbances', 'confusion', and 'schizophrenia' are symptom categories or diagnoses, while 'Cushing's disease' is the name of a specific syndrome.
Differentiate between a syndrome/disease and its manifestations. A manifestation is a component of the disease, not the disease itself.
Recall or deduce the most common psychiatric effects of hypercortisolism. The link between stress hormones (cortisol) and mood (affect) is a fundamental concept in psychoneuroimmunology.
Conclude that affective disturbances are the most prominent and well-documented psychiatric manifestation of high cortisol levels, making it the best answer.

Concept Tested & Keywords

Concept Tested: Psychiatric manifestations of hypercortisolism (Cushing's syndrome)
Stem keywords: manifestations, raised level, cortisone, ACTH
Lead-in keywords: Which of the following
Negative lead-in flag: false

Question ID

QnbpoFFB-AIeiv5EAQTZIo

Reference Book

E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) pp. 2324-2326, 646-648, 7496-7498

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