Let's discuss another case.
A 48-year old woman is seen
for weight gain, easy bruising,
and worsening diabetes control.
She takes metformin
On exam, she has a blood pressure
of 172 over 90,
a heart rate of 77 beats per minute,
and a BMI of 35.
She has centripetal obesity
with livid stria,
and posterior neck fat pad,
as well as hirsutism on her chin
and anterior neck.
Her labs show 24-hour free cortisol
of 200 micrograms in 24 hours,
a midnight salivary cortisol
of 300 nanograms per ml,
and an ACTH level of less than
five picograms per ml.
What is the diagnosis?
In reviewing this
fairly complex presentation,
there are some signs and symptoms
that are worth noting.
First of all, these signs and symptoms
suggest cortisol excess.
This is manifested as weight gain, bruising,
centripetal wall fat distribution,
the presence of stria, and hirsutism.
Also, the labs show increased cortisol
and a suppressed ACTH.
This woman clearly has