A 39 year old woman has weight gain, proximal muscle weakness, easy bruising, facial rounding, and purple abdominal striae. Testing shows elevated 24 hour urinary free cortisol that is not suppressed by low dose dexamethasone but is suppressed by high dose dexamethasone. Which of the following is the most likely source of her hypercortisolism?
- A)Exogenous glucocorticoid use
- B)Adrenal cortical adenoma
- C)Primary adrenal insufficiency
- D)Pituitary corticotroph adenomaGABARITO
- E)Small cell carcinoma of the lung
Explicação
Suppression with high dose dexamethasone indicates ACTH dependent hypercortisolism from a pituitary source, which is Cushing disease. Pituitary corticotroph adenomas retain some feedback responsiveness, unlike ectopic ACTH producing tumors. The classic clinica... Ver explicação completa e trilha adaptativa →