A 42-year-old woman presents to clinic with a 6-month history of progressive fatigue, weight gain, and cold intolerance. She denies easy bruising, proximal weakness, or skin changes. Vital signs are BP 158/92 mmHg, HR 68/min, RR 14/min, temperature 36.8°C. Physical examination reveals central obesity without striae or hirsutism. Serum TSH is 2.1 mIU/L (normal). Morning cortisol is 16 μg/dL (normal range 10–20 μg/dL), and midnight cortisol is 11 μg/dL (normal <7.5 μg/dL). Low-dose dexamethasone suppression test shows cortisol suppression to 2 μg/dL. Abdominal CT shows a 1.3-cm left adrenal nodule with benign imaging features. Which of the following is the most likely diagnosis?
- A)Overt Cushing syndrome
- B)Primary hypothyroidism
- C)Pseudo-Cushing syndrome
- D)Subclinical Cushing syndromeGABARITO
- E)Primary adrenal insufficiency
Explicação
Subclinical Cushing syndrome is characterized by autonomous cortisol secretion from an adrenal nodule WITHOUT clinical features of overt hypercortisolism. This patient has an elevated midnight cortisol (11 μg/dL, normal <7.5) indicating loss of normal diurnal ... Ver explicação completa e trilha adaptativa →