#Clinical_Case_En

A 38-year-old woman comes to the office with a 3-week history of weight loss, nausea, abdominal pain, and postural dizziness. She traveled to Thailand 6 months ago and has felt fatigued since then. Medical history is notable for moderate persistent asthma treated with an inhaled beta-2 agonist and inhaled corticosteroid. Over the last 2 years, the patient has had several asthma exacerbations requiring oral prednisone. She also has hypothyroidism treated with levothyroxine. The patient is married and is a stay-at-home mother. Blood pressure is 90/60 mm Hg and pulse is 96/min. Pharyngeal examination shows bilateral tonsillar enlargement. Skin examination shows increased pigmentation at the palmar creases and mucous membranes as well as a few patches of vitiligo. Initial laboratory testing shows mild hyponatremia and hyperkalemia with normal renal function. Complete blood count is normal, but differential shows moderate eosinophilia. Follow-up testing confirms a low 8 AM serum cortisol. Which of the following is the most likely cause of this patient's adrenal insufficiency?

A 38-year-old woman comes to the office with a 3-week history of weight loss, nausea, abdominal pain, and postural dizziness. She traveled to Thailand 6 months ago and has felt fatigued since then. Medical history is notable for moderate persistent asthma treated with an inhaled beta-2 agonist and inhaled corticosteroid. Over the last 2 years, the patient has had several asthma exacerbations requiring oral prednisone. She also has hypothyroidism treated with levothyroxine. The patient is married and is a stay-at-home mother. Blood pressure is 90/60 mm Hg and pulse is 96/min. Pharyngeal examination shows bilateral tonsillar enlargement. Skin examination shows increased pigmentation at the palmar creases and mucous membranes as well as a few patches of vitiligo. Initial laboratory testing shows mild hyponatremia and hyperkalemia with normal renal function. Complete blood count is normal, but differential shows moderate eosinophilia. Follow-up testing confirms a low 8 AM serum cortisol. Which of the following is the most likely cause of this patient's hypercalcemia?