2nd May 2024

A 45-year-old woman presents to the clinic with a history of progressive weight gain, facial rounding, and muscle weakness.

A 45-year-old woman presents to the clinic with a history of progressive weight gain, facial rounding, and muscle weakness. She has developed purple striae over her abdomen and has been experiencing irregular menstrual periods. Her past medical history is notable for type 2 diabetes and hypertension. On examination, she has central obesity, facial plethora, and proximal muscle weakness.

Investigations:

Serum cortisol (8 am): Elevated

ACTH: Suppressed

Dexamethasone suppression test: No suppression

Which is the most appropriate initial treatment?