A 38-year-old woman presents with progressive bifrontal headache and bitemporal hemianopsia. Vital signs show BP 158/94 mmHg, HR 88/min, RR 16/min, Temp 37.2°C. She denies recent weight gain. Labs reveal ACTH 78 pg/mL, 24-hour urinary cortisol 180 mcg/24hr, low-normal DHEA-S, and normal TSH. MRI demonstrates a 6-mm sellar mass with suprasellar extension. Which diagnosis best explains these findings?
- A)Iatrogenic Cushing syndrome from glucocorticoid use
- B)Adrenocorticotropic hormone-independent macronodular adrenal hyperplasia
- C)Ectopic ACTH secretion from lung carcinoma
- D)Cushing syndrome due to ACTH-secreting pituitary adenomaGABARITO
- E)Primary adrenal adenoma
Explicação
Cushing disease (pituitary ACTH adenoma) presents with elevated ACTH and urinary cortisol. The pituitary MRI lesion confirms the source. Low-normal DHEA-S can occur due to ACTH suppression of CRH feedback. Ver explicação completa e trilha adaptativa →