<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 53-year-old woman comes to the physician because of progressive headache and fatigue for the past 2 months. One year ago, she was diagnosed with Cushing disease, which was ultimately treated with bilateral adrenalectomy. Current medications are hydrocortisone and fludrocortisone. Examination shows generalized hyperpigmentation of the skin and bitemporal visual field defects. Serum studies show an ACTH concentration of 1250 pgmL N 20100. Which of the following is the most appropriate next step in management?? A: Administer bromocriptine, B: Administer metyrapone, C: Perform radiotherapy of the pituitary, D: Reduce dosage of glucocorticoids, E: Resect small cell lung carcinoma,  <response>: This is a clinical vignette describing a 53-year-old woman with a history of Cushing disease status post bilateral adrenalectomy who now presents with headaches, fatigue, hyperpigmentation, and bitemporal visual field defects. She is on glucocorticoid replacement. Lab testing shows very elevated ACTH levels. The key findings here are:- History of Cushing disease treated with bilateral adrenalectomy - New onset headaches, fatigue, hyperpigmentation, bitemporal visual field defects- Very high ACTH levelsThis indicates the patient now likely has Nelsons syndrome - a pituitary tumor leading to very high ACTH levels after bilateral adrenalectomy for Cushing disease. The choices provided are different medications or treatments that could be used in Cushing disease or ACTH-secreting tumors. However, in a patient with Nelsons syndrome after bilateral adrenalectomy, the most appropriate next step would be to resect the pituitary tumor overproducing ACTH. C: Perform radiotherapy of the pituitary 