A 58-year-old woman presented with excessive weight gain, abdominal bloating and tiredness. Over the next few months she had excessive facial hair growth, easy bruising and increased pigmentation of skin. Examination showed excess facial hair, moon-shaped face, centripetal obesity, purple striae on abdominal wall, an obvious buffalo hump and some areas of pigmentation in her skin. Systems examination revealed proximal myopathy and a blood pressure of 152/82. Routine blood tests were all normal. 24-hour urinary Cortisol was 3,082 nmol/d (0-260). Nine am Cortisol was 855 nmol/1 with midnight Cortisol reaching 349 nmol/1. Thyroid function tests, 24 urinary catecholamines and serum testosterone were all normal. Chest X-ray was normal.
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