Adrenal: Cushing syndrome surgery: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Adrenal: Cushing syndrome surgery

Sample item

A 35-year-old woman with a cortisol-secreting right adrenal adenoma is scheduled for laparoscopic adrenalectomy. Which perioperative measure is essential?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Perioperative hydrocortisone with a later taper

Chronic cortisol excess suppresses ACTH, so the contralateral adrenal is atrophic. After removing the adenoma she is at risk of adrenal crisis, so glucocorticoid is given perioperatively and tapered, with testing of the axis before it is stopped. Recovery can take months.

Option by option

  • A. Perioperative hydrocortisone with a later taper (correct)

    Correct. Replacement prevents adrenal crisis while the suppressed gland recovers.

  • B. Preoperative alpha-blockade

    Alpha-blockade is needed for phaeochromocytoma, which is not suspected here.

  • C. No steroid cover, since cortisol was in excess

    The contralateral gland is atrophic, so omitting cover risks an acute adrenal crisis.

  • D. Postoperative fludrocortisone alone

    Fludrocortisone is a mineralocorticoid and does not replace cortisol.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is A, Perioperative hydrocortisone with a later taper. Chronic cortisol excess suppresses ACTH, so the contralateral adrenal is atrophic.

Why is "Preoperative alpha-blockade" not the answer?

Alpha-blockade is needed for phaeochromocytoma, which is not suspected here.

Why is "No steroid cover, since cortisol was in excess" not the answer?

The contralateral gland is atrophic, so omitting cover risks an acute adrenal crisis.

Why is "Postoperative fludrocortisone alone" not the answer?

Fludrocortisone is a mineralocorticoid and does not replace cortisol.

What concept does this question test?

It tests Adrenal: Cushing syndrome surgery in General Surgery. After removing the adenoma she is at risk of adrenal crisis, so glucocorticoid is given perioperatively and tapered, with testing of the axis before it is stopped. Recovery can take months.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Adrenal: Cushing syndrome surgery?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.