MRCP2-1489

MRCP2-1489

A 32-year-old woman presents to your clinic with complaints of weight gain and irregular periods. Upon examination, her heart rate is 95 bpm and blood pressure is 155/92 mmHg. Her lab results show a low Hb level of 110 g/L, high MCV of 112 fl, and platelets within normal range at 199 * 109/L. Bilirubin and ALP levels are elevated at 17 µmol/L and 138 u/L, respectively, while ALT is slightly elevated at 55 u/L. Cortisol levels are high throughout the day, with a 9AM level of 461 nmol/L, midnight level of 154 nmol/L, and a rise to 645 nmol/L following an insulin stress test. Urine free cortisol is also elevated at 802 nmol/24h, while ACTH is within normal range at 13.3 pmol/L. Imaging studies show fatty changes in the liver but are otherwise unremarkable. What is the most likely diagnosis for this patient?