<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 33-year-old woman presents to the physician because of abdominal discomfort, weakness, and fever. She has had a significant weight loss of 15 kg 33.1 lb over the past 2 months. She has no history of medical illness and is not on any medications. Her pulse is 96min, the blood pressure is 16792 mm Hg, the respiratory rate is 20min, and the temperature is 37.7C 99.8F. Her weight is 67 kg 147.71 lb, height is 160 cm 5 ft 3 in, and BMI is 26.17 kgm2. Abdominal examination shows purple striae and a vaguely palpable mass in the left upper quadrant of the abdomen, which does not move with respirations. She has coarse facial hair and a buffalo hump along with central obesity. Her extremities have poor muscle bulk, and muscle weakness is noted on examination. An ultrasound of the abdomen demonstrates an adrenal mass with para-aortic lymphadenopathy. Which of the following is the most likely laboratory profile in this patient?? A: Normal glucose tolerance, elevated serum cortisol, normal 24-h urinary free cortisol, and normal plasma adrenocorticotropic hormone ACTH, B: Impaired glucose tolerance, elevated serum cortisol, elevated 24-h urinary free cortisol, and high plasma ACTH, C: Impaired glucose tolerance, elevated serum cortisol, elevated 24-h urinary free cortisol, and low plasma ACTH, D: Impaired glucose tolerance, reduced serum cortisol, normal 24-h urinary free cortisol, and low plasma ACTH, E: Impaired glucose tolerance, elevated serum cortisol, normal 24-h urinary free cortisol, and normal plasma ACTH,  <response>: This is a clinical vignette describing a patient with signs and symptoms of Cushings syndrome, including abdominal discomfort, weakness, fever, significant weight loss, high blood pressure, abdominal striae, buffalo hump, central obesity, poor muscle bulk, and muscle weakness. Imaging reveals an adrenal mass and para-aortic lymphadenopathy. The question asks about the most likely laboratory findings in this patient with suspected Cushings syndrome. Based on the clinical presentation, the leading diagnosis is Cushings disease due to an ACTH-secreting pituitary tumor. This would lead to elevated ACTH levels from the pituitary tumor, which drives excess cortisol production from the adrenal glands. Therefore, the lab profile most consistent with Cushings disease is option C - impaired glucose tolerance, elevated serum cortisol, elevated 24-hour urinary free cortisol, and low plasma ACTH levels due to negative feedback from high cortisol.C: Impaired glucose tolerance, elevated serum cortisol, elevated 24-h urinary free cortisol, and low plasma ACTH 