Diabetes Mellitus USMLE Step 1 Practice Question
A 52-year-old man with central obesity presents with new-onset diabetes, hypertension (BP 158/96 mmHg), and purple abdominal striae. He takes metformin but remains hyperglycemic. Vital signs show HR 88/min, RR 16/min, temperature 37.2°C. Laboratory studies reveal elevated 24-hour urinary free cortisol (285 mcg/24h; normal <50), suppressed ACTH (2 pg/mL), and fasting glucose 186 mg/dL. Abdominal CT demonstrates a unilateral 2.5-cm adrenal mass. Hirsutism is absent. Which diagnosis best explains his clinical presentation?
Answer choices
- AAdrenal cortisol producing adenomaCorrect answer
- BAddison disease
- CSmall cell lung carcinoma
- DACTH secreting pituitary microadenoma
- EEctopic CRH producing tumor
- FPrimary hyperaldosteronism with concurrent metabolic syndrome
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