Adrenal Disorders USMLE Step 1 Practice Question
A 35-year-old woman presents to clinic with a 6-month history of progressive hypertension, central weight gain, and easy bruising. She denies exogenous corticosteroid use. Vital signs: BP 172/108 mmHg, HR 88/min, RR 16/min, T 37.2°C. On examination, she has central obesity with proximal muscle weakness, violaceous striae, and hypertrichosis. Laboratory studies: AM Cortisol: 95 µg/dL (normal 5–20)
PM Cortisol: 92 µg/dL (normal 2.5–10)
AM ACTH: 58 pg/mL (normal 10–46)
Dexamethasone suppression test (1 mg overnight): Cortisol 78 µg/dL
Dexamethasone suppression test (8 mg overnight): Cortisol 22 µg/dL (normal <5 µg/dL after 8 mg is still abnormal but shows partial suppression) What is the most likely diagnosis?
Answer choices
- AAdrenocortical adenoma
- BEctopic corticotropin-releasing hormone (CRH)-secreting tumor
- CEctopic adrenocorticotropic hormone (ACTH)-secreting neoplasm
- DPituitary corticotroph adenoma (Cushing disease)Correct answer
- EIatrogenic Cushing syndrome from chronic glucocorticoid therapy
- FAdrenal carcinoma with autonomous cortisol production
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