Primary adrenal insufficiency Quiz: Ace Your Exams

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A 9-year-old female is brought to her pediatrician for evaluation of acne. The patient has been doing well in school and has not had any recent infections or health issues. However, she has been having worsening acne despite over the counter treatments. She has no previous medical problems and does not take any medications. Temperature is 37.0°C (98.6°F), pulse is 90/min, respirations are 16/min, blood pressure is 152/71 mmHg, and oxygen saturation is 98% on room air. Physician exam is notable for moderate facial acne, scant facial hair, and increased upper body muscle tone for age. Which of the following is the most likely diagnosis?

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