Cushing Syndrome

A 38-year-old woman presents with progressive weight gain, proximal muscle weakness, easy bruising, and amenorrhea for 8 months. Clinical examination reveals central obesity, purple striae, and hypertension (160/100 mmHg). You suspect Cushing syndrome. Which investigation is the best initial screening test?

A 52-year-old man with confirmed hypercortisolism (elevated 24-hour UFC and abnormal LDDST) is being investigated for the cause of Cushing syndrome. His ACTH level is 8 pg/mL (normal 10–46 pg/mL). Which is the most appropriate next investigation to localize the source?

A 52-year-old man with ACTH-independent Cushing syndrome due to a 4 cm adrenocortical carcinoma is deemed unresectable by the surgical team. Medical therapy is initiated for long-term cortisol suppression. Which drug is the first-line choice for this indication?

A 52-year-old woman with a 6-month history of progressive proximal muscle weakness, hypertension, and hirsutism is found to have elevated 24-hour urinary free cortisol and suppressed ACTH. Imaging reveals a 2 cm left adrenal mass. Which single feature best distinguishes adrenocorticotropic hormone (ACTH)-independent Cushing syndrome from ACTH-dependent Cushing syndrome in this patient?

A 38-year-old woman presents with progressive central obesity, proximal muscle weakness, and easy bruising. Laboratory investigations show elevated 24-hour urinary free cortisol and loss of normal circadian rhythm of cortisol. All of the following are recognized features of Cushing syndrome EXCEPT: