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Cushing's disease — SCE Endocrinology MCQ

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HardPituitaryCushing's diseaseSCE Endocrinology

A 45-year-old woman has central obesity, bruising and proximal myopathy. Low-dose dexamethasone does not suppress cortisol, ACTH is detectable and pituitary MRI shows a 6 mm lesion. IPSS shows central ACTH gradient. What is the most likely diagnosis?

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Correct answer: C — Cushing's disease

ACTH-dependent hypercortisolism with central gradient on IPSS supports pituitary ACTH secretion, or Cushing's disease. Adrenal cortisol-producing adenoma suppresses ACTH. Pseudo-Cushing's should be considered clinically but IPSS with clear central gradient supports true pituitary disease.

Reference: Endocrine Society Cushing's Syndrome Guideline