Hypertension and Oligomenorhoea

🗒️ Question

A 36 year old woman presents with a six month history of weight gain, bruising and oligomenorhoea. She also complains of feeling fatigued and experiencing mood swings.

On examination, she has a BMI of 30 kg/m², facial plethora, abdominal striae and proximal muscle weakness. She has mild hypertension with a blood pressure of 145/92 mmHg.

Investigations

• Serum cortisol: 650 nmol/L (160–600 nmol/L at 9 am)

• Serum potassium: 3.1 mmol/L (3.5–5.3)

• 24-hour urinary free cortisol: Elevated

What is the most likely diagnosis?

(A) Adrenal adenoma

(B) Cushing's disease

(C) Ectopic ACTH syndrome

(D) Exogenous glucocorticoid use

(E) Polycystic ovary syndrome