Morning ACTH and cortisol are 75 pg/mL (10-50), 35 μg/dL (10-20), respectively


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A 58-year-old Midwest American male presents with fever, proximal muscles weakness that improves with activity, dyspnoea, central weight gain, spared eyes, coughing rust-coloured sputum that is getting worse, round, red and full face and fatigue. The patient had 2 years an acute MI and took some ACEIs and other drugs for some time. He has 8 months ago a corneal transplantation in his left eye and thus prescribed prednisone (steroid) eye drops. The patient is a smoker (2 packs/daily). MRI imaging of the head shows a very white pituitary gland with 5mm in height (3-8 mm). Compound motor action potentials show small ampules, and normal latency and velocities. MRI imaging of adrenal glands shows lighter cortex and darker medulla. The right adrenal gland looks pyramidal 5.5mm in width (<6.1 mm). The adrenal glands look enlarged, but with their normal shapes, and the left one is wider. Imagine of the lung shows obstruction and central lesion and no cartilaginous or calcified structures notice. No history of tuberculosis or fungal infections. Blood and urine tests show normal creatinine kinase and normal thyroid hormones, normal calcium, normal 5-HIAA and autoantibodies against calcium channels. Morning ACTH and cortisol are 75 pg/mL (10-50), 35 μg/dL (10-20), respectively. The patient is most likely to have:

A) Cushing’s disease
Β) Primary Cushing’s syndrome
C) Exogenous steroid-induced Cushing’s syndrome
D) Pulmonary granuloma
E) Bronchial hamartoma
F) Pulmonary squamous cell carcinoma
G) Pulmonary small cell carcinoma
H) Carcinoid syndrome