A 33-year-old woman presents to the physician because of abdominal discomfort, weakness, and fever. She has had a significant weight loss of 15 kg (33.1 lb) over the past 2 months. She has no history of medical illness and is not on any medications. Her pulse is 96/min, the blood pressure is 167/92 mm Hg, the respiratory rate is 20/min, and the temperature is 37.7°C (99.8°F). Her weight is 67 kg (147.71 lb), height is 160 cm (5 ft 3 in), and BMI is 26.17 kg/m2. Abdominal examination shows purple striae and a vaguely palpable mass in the left upper quadrant of the abdomen, which does not move with respirations. She has coarse facial hair and a buffalo hump along with central obesity. Her extremities have poor muscle bulk, and muscle weakness is noted on examination. An ultrasound of the abdomen demonstrates an adrenal mass with para-aortic lymphadenopathy. Which of the following is the most likely laboratory profile in this patient?
AImpaired glucose tolerance, elevated serum cortisol, elevated 24-h urinary free cortisol, and high plasma ACTH
BNormal glucose tolerance, elevated serum cortisol, normal 24-h urinary free cortisol, and normal plasma adrenocorticotropic hormone (ACTH)
CImpaired glucose tolerance, elevated serum cortisol, elevated 24-h urinary free cortisol, and low plasma ACTH
DImpaired glucose tolerance, reduced serum cortisol, normal 24-h urinary free cortisol, and low plasma ACTH
EImpaired glucose tolerance, elevated serum cortisol, normal 24-h urinary free cortisol, and normal plasma ACTH
A 15-year-old female is brought to the emergency room with high fever and confusion. She complains of chills and myalgias, and physical examination reveals a petechial rash. Petechial biopsy reveals a Gram-negative diplococcus. The patient is at greatest risk for which of the following?
APelvic inflammatory disease
BSeptic arthritis
CBilateral adrenal destruction
DOsteomyelitis
EAcute endocarditis
A 32-year-old man presents with hypertension that has been difficult to control with medications. His symptoms include fatigue, frequent waking at night for voiding, and pins and needles in the legs. His symptoms started 2 years ago. Family history is positive for hypertension in his mother. His blood pressure is 160/100 mm Hg in the right arm and 165/107 mm Hg in the left arm, pulse is 85/min, and temperature is 36.5°C (97.7°F). Physical examination reveals global hyporeflexia and muscular weakness. Lab studies are shown: Serum sodium 147 mEq/L Serum creatinine 0.7 mg/dL Serum potassium 2.3 mEq/L Serum bicarbonate 34 mEq/L Plasma renin activity low Which of the following is the most likely diagnosis?
ARenal artery stenosis
BCoarctation of aorta
CCushing syndrome
DPrimary aldosteronism
EEssential hypertension
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