A 35 yo female presents to your clinic. She states she has not had a cycle in 6 months, has noticeably more acne

A 35 yo female presents to your clinic. She states she has not had a cycle in 6 months, has noticeably more acne, and recently is starting to show facial hair. She also has been gaining weight and currently weighs 230 pounds. She is concerned she has PCOS and wants to be tested. She also states she is very thirsty and is urinating a lot along with she has a quick temper lately. Upon Physical exam you notice. Abdominal striae her limbs seem “thin” in comparison to her trunk size In areas that are not exposed to the sun the skin seems to look “tan” Blood pressure is 160/95 You decide to run lab work , below are the pertinent results Blood sugar is (High) Blood Cortisol is high Blood Sodium is high Blood potassium is low Aldosterone is High ACTH is high

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