Pituitary adenoma Quiz: Ace Your Exams
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A 41-year-old woman comes to her outpatient provider because of skin changes that began three-months ago. She has noticed increased bruising and the development of purple-red stretch marks on the abdomen. Past medical history is notable for asthma, for which she intermittently uses a budesonide inhaler. She smokes half-a-pack of cigarettes per day. In the office, her temperature is 37.7°C (99.9°F), pulse is 71/min, respirations are 19/min, and blood pressure is 142/85 mmHg. Physical exam confirms the presence of ecchymoses and abdominal striae. Laboratory testing reveals the following findings:
*Normal range: 4-40 µg/day
**Normal range: 5-20 pg/mL
The serum cortisol levels are significantly reduced in response to a high-dose of dexamethasone. Which of the following is the most likely underlying pathophysiology for this patient’s condition?
| Laboratory value | Result |
| Sodium | 146 mmol/L |
| Potassium | 3.9 mmol/L |
| Bicarbonate | 26 mmol/L |
| Fasting glucose | 137 mg/dL |
| 24-hour urine cortisol* | 72 µg/day |
| Serum ACTH** | 35 pg/mL |
*Normal range: 4-40 µg/day
**Normal range: 5-20 pg/mL
The serum cortisol levels are significantly reduced in response to a high-dose of dexamethasone. Which of the following is the most likely underlying pathophysiology for this patient’s condition?
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