A 27-year-old woman gained 68.2-kg weight over the previous year. She had been taking lithium for a personality disorder and obsessive-compulsive disorder.
She was taking levothyroxine for primary hypothyroidism, pain medication, and antidepressants. secondary amenorrhea for 3 years strong family history of obesity Physical Examination: BMI of 78 kg/m2 (height, 152.4 cm; weight, 181.8 kg) 4+ lower extremity tense edema cushingoid features obstructive sleep apnea Lab results: mean corpuscular volume,104.2 μm3; thyrotropin, 22.57 mIU/L; 24-hour urinary free cortisol, 223.1 μg/24 h; 11 PM serum cortisol, 19.3 μg/dL ; 11 PM salivary cortisol, 7.0 ng/dL (repeated measurements: 136.0 ng/dL and 34.3 ng/dL; overnight 1-mg dexamethasone suppressed cortisol to 1.3 μg/dL, and again to 0.8 μg/dL; corticotropin, 55 pg/mL ; bioavailable testosterone, 8.7 ng/dL; 25-hydroxyvitamin D3, 4.2 ng/dL; and…
