<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 47-year-old woman complains of weight gain and irregular menses for the past 2 years. She has gained 13 kg 28,6 lb and feels that most of the weight gain is in her abdomen and face. She has type 2 diabetes and hypertension for 1 year, and they are difficult to control with medications. Vital signs include a temperature of 36.9C 98.4F, blood pressure of 160100 mm Hg, and pulse of 95min. The patient late-night salivary cortisol is elevated. Morning plasma ACTH is high. Brain magnetic resonance imaging shows a 2 cm pituitary adenoma. Which of the following is the optimal therapy for this patient?? A: Pituitary radiotherapy, B: Medical therapy, C: Unilateral adrenalectomy, D: Bilateral adrenalectomy, E: Transsphenoidal pituitary adenoidectomy,  <response>: This is a patient with signs and symptoms of Cushings disease, including weight gain, irregular menses, hypertension, diabetes that is difficult to control, and elevated late-night salivary cortisol and morning plasma ACTH. Imaging shows a pituitary adenoma, confirming the diagnosis of Cushings disease due to an ACTH-secreting pituitary tumor. The optimal treatment is surgical removal of the pituitary adenoma, which is the source of excess ACTH production driving cortisol overproduction. Choice E, transsphenoidal pituitary adenoidectomy, is therefore the best answer. Choices A, B, C, and D are incorrect as they do not treat the underlying cause of excess ACTH production from the pituitary tumor. E: Transsphenoidal pituitary adenoidectomy 