A 64-year-old male underwent general anesthesia for a primary coronary artery bypass graft (CABG) of his left anterior descending (LAD) artery using the left internal mammary artery (LIMA). His other medical history is insignificant. Intraoperative cell salvage was used throughout the case, including dissection of the IMA. The procedure itself was uneventful; however, while closing the wound, the autologous blood was reinfused resulting in immediate and profound hypotension (see figure).

	Allan Klompas, M.B., M.Ch., BAO Fellow, Transfusion Medicine Mayo Clinic
	Paula Santrach, M.D. Consultant, Transfusion Medicine Mayo Clinic Associate Professor of Laboratory Medicine and Pathology Mayo Clinic College of Medicine

A 57-year-old female presented with easy bruising, hirsutism, and weight loss. Morning serum cortisol was 54.1 mcg/dL (reference interval (RI): 7-25 mcg/dL) with an adrenocorticotropic hormone (ACTH) of 35 pg/mL (RI: 7-63 mcg/dL). Following a high-dose dexamethasone suppression test, cortisol was 4.1 mcg/dL with an ACTH of 17 pg/mL. Inferior petrosal sinus sampling following administration of corticotropin-releasing hormone was performed. At baseline, the central-to-peripheral ACTH gradient was 2.8-to-1. After administering CRH, this central-to-peripheral ACTH ratio was 23-to-1.
This quiz is no longer available.

	Kornelia Galior, Ph.D. Fellow, Clinical Chemistry Mayo Clinic
	Stefan Grebe, M.D., Ph.D. Consultant, Clinical Chemistry Mayo Clinic Professor of Laboratory Medicine and Pathology Mayo Clinic College of Medicine

A 57-year-old female presented with easy bruising, hirsutism, and weight loss. Morning serum cortisol was 54.1 mcg/dL (reference interval (RI): 7-25 mcg/dL) with an adrenocorticotropic hormone (ACTH) of 35 pg/mL (RI: 7-63 mcg/dL). Following a high-dose dexamethasone suppression test, cortisol was 4.1 mcg/dL with an ACTH of 17 pg/mL. Inferior petrosal sinus sampling following administration of corticotropin-releasing hormone was performed. At baseline, the central-to-peripheral ACTH gradient was 2.8-to-1. After administering CRH, this central-to-peripheral ACTH ratio was 23-to-1.
This quiz is no longer available.

	Kornelia Galior, Ph.D. Fellow, Clinical Chemistry Mayo Clinic
	Stefan Grebe, M.D., Ph.D. Consultant, Clinical Chemistry Mayo Clinic Professor of Laboratory Medicine and Pathology Mayo Clinic College of Medicine

This incidental miscroscopic finding is observed in both ovaries in a 40-year-old woman who has undergone prophylactic hystero-salpingo-oophorectomy.

	Yifan Zhang Resident, Department of Pathology and Cytology Karolinska Institutet
	Joseph Carlson, M.D., Ph.D. Senior Consultant, Department of Pathology and Cytology Karolinska Institutet