8 A 40-year-old man sees his physician because he has had headache, weakness, and a 5-kg weight gain over the past 3
months. He has experienced mental depression for the past 3 months and has been prescribed antidepressants. On
physical examination, his face is puffy. His temperature is 36.9°C, pulse is 79/min, respirations are 15/min, and blood
pressure is 160/75 mm Hg while lying down. He has cutaneous striae over the lower abdomen and ecchymoses scattered
over the extremities. A radiograph of the spine shows a compressed fracture of T11. Laboratory findings show a fasting
plasma glucose level of 200 mg/dL, serum Na+ of 150 mmol/L, and serum K+ of 3.1 mmol/L. The plasma cortisol level is
38 μg/dL at 8:00 am and 37 μg/dL at 6:00 pm. Administration of low and high doses of dexamethasone fails to suppress
the plasma cortisol level and excretion of urinary 17-hydroxycorticosteroids. The plasma corticotropin level is 0.8 pg/mL.
Which of the following lesions is most likely to be present in this man?
□ (A) Adenoma of the right adrenal cortex with atrophy of the contralateral adrenal cortex
□ (B) Small-cell carcinoma of the lung with bilateral hyperplasia of the adrenal cortex
□ (C) Corticotroph adenoma of the anterior pituitary with bilateral hyperplasia of the adrenal cortex
□ (D) Adenoma of the right adrenal cortex without atrophy of contralateral adrenal cortex
□ (E) Corticotroph adenoma of the anterior pituitary, medullary carcinoma of thyroid, and bilateral nodular hyperplasia
of the adrenal cortex
months. He has experienced mental depression for the past 3 months and has been prescribed antidepressants. On
physical examination, his face is puffy. His temperature is 36.9°C, pulse is 79/min, respirations are 15/min, and blood
pressure is 160/75 mm Hg while lying down. He has cutaneous striae over the lower abdomen and ecchymoses scattered
over the extremities. A radiograph of the spine shows a compressed fracture of T11. Laboratory findings show a fasting
plasma glucose level of 200 mg/dL, serum Na+ of 150 mmol/L, and serum K+ of 3.1 mmol/L. The plasma cortisol level is
38 μg/dL at 8:00 am and 37 μg/dL at 6:00 pm. Administration of low and high doses of dexamethasone fails to suppress
the plasma cortisol level and excretion of urinary 17-hydroxycorticosteroids. The plasma corticotropin level is 0.8 pg/mL.
Which of the following lesions is most likely to be present in this man?
□ (A) Adenoma of the right adrenal cortex with atrophy of the contralateral adrenal cortex
□ (B) Small-cell carcinoma of the lung with bilateral hyperplasia of the adrenal cortex
□ (C) Corticotroph adenoma of the anterior pituitary with bilateral hyperplasia of the adrenal cortex
□ (D) Adenoma of the right adrenal cortex without atrophy of contralateral adrenal cortex
□ (E) Corticotroph adenoma of the anterior pituitary, medullary carcinoma of thyroid, and bilateral nodular hyperplasia
of the adrenal cortex