Diseases of the Endocrine System
A 52-year-old female is being seen by her family physician. Over the past year, she has gained 45 lbs., which is concentrated mostly in her abdominal region. She also complains of fatigue and weakness in her arms. Her vital signs are a temperature of 98.7°F, pulse of 89 bpm, and blood pressure of 157/93 mm Hg. A physical examination reveals the patient to have comparatively small arms and thighs, abdominal striae, and hair on her upper lip. Laboratory testing reveals a blood glucose concentration of 173 mg/dL. Her serum cortisol concentration, drawn at 3:00 pm, is 44 μg/dL. A low-dose dexamethasone test does not elicit a change in the cortisol concentration, but after a high-dose dexamethasone suppression test, the cortisol concentration decreases to 21 μg/dL. Of the following, what is the most likely source of her elevated cortisol?
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