Adrenal Disorders

A 38-year-old woman from Mumbai presents with progressive fatigue, weight loss of 8 kg over 3 months, and recurrent hypoglycaemic episodes. On examination, she is hypotensive (BP 100/65 mmHg) with generalised hyperpigmentation of the skin and oral mucosa. Laboratory investigations reveal: sodium 128 mEq/L, potassium 5.8 mEq/L, fasting blood glucose 65 mg/dL, and cortisol at 8 AM: 2.2 µg/dL (normal: 10–20 µg/dL). ACTH level is 156 pg/mL (normal: 10–50 pg/mL). Abdominal CT shows bilateral adrenal atrophy. What is the most likely diagnosis?

A 52-year-old man from Delhi presents with severe headache, profuse sweating, and palpitations. Blood pressure is 185/115 mmHg with marked variability (ranging from 160/100 to 210/130 mmHg over 30 minutes). He reports episodic attacks of anxiety, tremor, and chest tightness lasting 15–30 minutes, occurring 2–3 times per week for the past 6 months. Fasting plasma glucose is 156 mg/dL. Abdominal imaging reveals a 3 cm right adrenal mass. Plasma free metanephrine is 4.2 nmol/L (normal: <0.9 nmol/L) and plasma normetanephrine is 2.8 nmol/L (normal: <0.9 nmol/L). What is the most likely diagnosis?

Which enzyme deficiency is responsible for the most common form of congenital adrenal hyperplasia (CAH)?

In Cushing syndrome, which of the following is the most sensitive and specific screening test?