Endocrinology Question 23

A 40-year-old woman is evaluated for amenorrhea of 4 months' duration. She has had weight gain, facial hair, alopecia, and debilitating fatigue. Her medical history is significant for psoriasis. She seems to be gaining weight in her face, abdomen, and neck. She also bruises easily. Her only medication is clobetasol for psoriasis.

On physical examination, temperature is 37.6 °C (99.7 °F), blood pressure is 148/90 mm Hg, pulse rate is 88/min, and respiration rate is 12/min. BMI is 38. She is obese with a round face. She has terminal hairs on her chin, upper lip, chest, and back. Mild facial acne, central obesity, and a few wide purple striae on the back of her arms are also noted. She has supraclavicular fat. Her skin has psoriatic plaques. Muscle strength in the upper and lower extremities is 4/5.

Which of the following is the most likely diagnosis?

A Adrenocortical carcinoma

B Cushing disease

C Ectopic adrenocorticotropic hormone production

D Iatrogenic Cushing syndrome

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