Question: 55 of 100 Time Remaining: 01:03:24 Pause Remaining: 00:05:00

A 10-year old presents with fatigue and weakness for the last month. His mother reports that they immigrated from India approximately 4 months ago and he was previously healthy other than a chronic cough for which he receives “breathing medicine.” She reports that he is up to-date on his vaccines and presents a copy showing full immunization. He lives at home with his parents, older sister, 3 cousins, aunt and uncle and no one at home is ill On examination, you note bronzing of the skin, especially in his palmar creases and buccal mucosa, and order additional testing: Random plasma cortisol: 5 mcg/dl, Plasma cortisol 30 minutes after ACTH administration: 7mcg/dt, ACTH: 350 pg/ml. What testis) will reveal the most likely etiology of this patient’s symptoms? 1. )Measurement of very long chain fatty acids (VLCFA) 2. CT scan 3. Hemoglobin Alc 4. )Chest X-ray and IGRA (interferon gamma release assay)

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