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Background In the evaluation of Cushing’s syndrome (CS), oral contraceptives may lead to false-positive results by raising the serum levels of cortisol-binding globulin (CBG). Clinical Case An 18-year old Chinese lady presented with weight gain, irregular menses and hirsutism. History was unremarkable for hypothyroidism, hyperprolactinemia, eating disorders, and exogenous steroid use. On examination, she was overweight (body mass index (BMI) 26.9 kg/m2) with rounded facies, hirsutism and dorsal cervical fat pad. Initial biochemical tests showed high cortisol and ACTH levels: ACTH 66.6 pmol/L (RI 0-10.2 pmol/L) and random cortisol 958 nmol/L (RI: 240-618 nmol/L). She was referred to our department for evaluation of possible Cushing’s syndrome. Further history revealed that the patient was on a combined estrogen-progestin oral contraceptive pill (OCP). Confirmatory tests after cessation of the OCP for 6 weeks revealed normal 24-hr urinary cortisol levels (231 and 255 nmol/day, RI: 59-413 nmol/day) and a normal 1 mg dexamethasone suppression test (44 nmol/L after administration of 1 mg dexamethasone overnight, RI

Knowledge of stroke symptoms is associated with seeking medical attention early, and knowledge of risk factors is an essential factor in stroke prevention. In this study, we evaluated the level of stroke literacy in Singapore.A cross-sectional study of Singapore citizens and permanent residents aged 21 years and above was conducted in a public housing estate. Participants were randomly sampled using multi-stage stratified sampling. Assessment of awareness of stroke symptoms and risk factors was performed using open-ended questions. In total, 687 respondents were recruited, with a response rate of 69.7%.Overall, 52.4% of respondents identified the brain as the source of pathology, and 47.6% could cite at least 1 of the 3 FAST symptoms (facial droop, arm weakness and speech difficulty), while 40% could name 2 or more of 7 established risk factors for stroke (high blood pressure, high cholesterol, cigarette smoking, diabetes mellitus, older age, previous heart attacks and stroke). Respondents at higher risk of stroke (older individuals and those with stroke risk factors) did not have greater awareness of stroke symptoms and risk factors. The majority of respondents reported they would seek immediate medical care if they experienced stroke symptoms. Only 59.4% knew the emergency ambulance service telephone number.In a sample of Singaporean adults residing in a public housing estate, we found evidence of poor stroke literacy, highlighting the need for comprehensive population-based education efforts. There is a role for opportunistic education among those at higher risk of stroke.