Correct!
4. Cushing disease
The patient’s presentation, including her ruddy complexion, difficult-to-control diabetes and hyperglycemia, weight gain, hypertension, and easy bruising are all consistent with excess cortisol production, or Cushing syndrome. Addison disease represents adrenal insufficiency, with typical symptoms including fatigue, hyperpigmentation, nausea / vomiting, diarrhea, abdominal pain, muscle pain, dehydration, hypoglycemia, and hypotension. Hyperaldosteronism reflects excessive aldosterone production, often from and adrenal gland adenoma [1°] or reduced renal perfusion [2°], and may be asymptomatic but often presents with hypertension refractory to medical therapy and electrolyte imbalances [hypokalemia]; the latter may present with muscle spasms, fatigue, polydipsia, polyuria, and paresthesia. Grace’s disease is autoimmune hyperthyroidism, with common presenting symptoms including unintentional weight loss, anxiety, fine motor tremor, heat sensitivity, frequent bowel movements, fatigue, and skin changes.
Which of the following represents an appropriate next step for the evaluation of this patient (Click on the correct answer to be directed to the fourth of twelve pages)