A 37-year-old woman comes to the physician because of irregular menses and generalized fatigue for the past 4 months. Menses previously occurred at regular 25- to 29-day intervals and lasted for 5 days but now occur at 45- to 60-day intervals. She has no history of serious illness and takes no medications. She is 155 cm (5 ft 1 in) tall and weighs 89 kg (196 lb); BMI is 37 kg/m2. Her temperature is 37°C (98.6°F), pulse is 90/min, and blood pressure is 146/100 mm Hg. Examination shows facial hair as well as comedones on the face and back. There are multiple ecchymotic patches on the trunk. Neurological examination shows weakness of the iliopsoas and biceps muscles bilaterally. Laboratory studies show: Hemoglobin 13.1 g/dL Leukocyte count 13,500/mm3 Platelet count 510,000/mm3 Serum Na+ 145 mEq/L K+ 3.3 mEq/L Cl- 100 mEq/L Glucose 188 mg/dL Which of the following is the most likely diagnosis?
APheochromocytoma
BCushing syndrome
CPrimary hyperaldosteronism
DPolycystic ovarian syndrome
EHypothyroidism
A 45-year-old woman comes to the physician because of fatigue, irregular menses, and recurrent respiratory infections for the past 6 months. Her blood pressure is 151/82 mm Hg. Physical examination shows a round face, thinning of the skin, and multiple bruises on her arms. Further studies confirm the diagnosis of an ACTH-secreting pituitary adenoma. This patient is at greatest risk for which of the following?
AWeight loss
BEosinophilia
CBitemporal hemianopsia
DHypoglycemia
EPathologic fracture
A 48-year-old woman presents to her primary care physician with complaints of persistent fatigue, dizziness, and weight loss for the past 3 months. She has a history of hypothyroidism and takes thyroxine replacement. Her blood pressure is 90/60 mm Hg in a supine position and 65/40 mm Hg while sitting, temperature is 36.8°C (98.2°F), and pulse is 75/min. On physical examination, there is a mild increase in thyroid size, with a rubbery consistency. Her skin shows diffuse hyperpigmentation, more pronounced in the oral mucosa and palmar creases. Which of the following best represent the etiology of this patient’s condition?
AProlonged corticosteroid therapy
B↓ corticotropin-releasing hormone secretion from the hypothalamus
CAutoimmune destruction of the adrenal gland
D↓ adrenocorticotropic hormone secretion from the pituitary gland
E↑ iron absorption and deposition in the body
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