Experienced mental depression

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Question

A 40 year old woman sees her primary care provider because she has had headache, weakness, and a 5 kg weight gain over the past 3 months. She has experienced mental depression for the past 3 months and has been prescribed antidepressants. On physical examination her face is puffy. Her temperature is 36.9 degrees C, pulse 79 bpm, respirations 15/min, and blood pressure 160/75 mm Hg while lying down. She has cutaneous striae over the lower abdomen and ecchymoses scattered over his extremities. Laboratory findings reveal fasting glucose 200 mg/dl, serum Na+ 250 mmol/L, and serum K+ 3.1 mmol/L. The plasma cortisol level 38 micro-grams/dL at 8:00 am and 37 micro-grams/dL at 6:00 pm. The most likely underlying pathophysiology of these clinical manifestations is • an adrenal adenoma which causes increased amounts of androgens • a tumor of the pituitary gland which secretes decreased amounts of ACTH • a tumor that arises outside the pituitary that produces oxytocin • an adrenal adenoma which causes decreased amounts of cortisol • a tumor of the pituitary gland which secretes increased amounts of ACTH

Reference no: EM133726621

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