A 35 year-old female presents with a weight gain of about 15 lbs in the last two years. She complains of mild weakness in her muscles when she gets up from a chair. She also has irregular light menstrual periods and has noticed the appearance of a few coarse hairs on her chin in last six months. She has a history of type 2 diabetes, depression, and seizures. Her medications include metformin, phenytoin, and sitagliptin.
Physical examination is notable for blood pressure (BP) of 140/90 mm Hg, a body mass index (BMI) of 34.1 kg/m2 (normal, 18.5 to 24.9 kg/m2), and central obesity. She has mild hirsutism on her chin, acanthosis nigricans on the nape of her neck, a small dorsocervical hump, abdominal striae, and a few ecchymoses.
Laboratory data were as follows:
Fasting glucose: 150 mg/dL (normal, 70-99 mg/dL)
Sodium (Na): 140 mmol/L (normal, 133-145 mmol/L)
Potassium (K): 3.4 mmol/L (normal, 3.5-5.5 mmol/L)
Thyroid-stimulating hormone (TSH): 0.50 µIU/mL (normal, 0.34-4.5 µIU/mL)
Total testosterone: 20 ng/dL (normal, 2-45 ng/dL)
17-Hydroxyprogesterone: 50 ng/dL (normal,
DHEA-sulfate: 230 µg/dL (normal, 18-391 µg/dL)
A 24-urine free cortisol (UFC) was 40 µg/24 hr (normal,