<prompt> A 17 year old female patient has hirsutism, hyperglycemia, obesity, muscle wasting, and increased circulating levels of ACTH. The most likely cause of her symptoms is:Primary adrenocoical insufficiencyPrimary overproduction of ACTHExogenous steroidsHypophysectomy  <response>: This female patients symptoms are classic for a primary elevation of ACTH Cushings Disease. Exogenous steroids would produce similar symptoms, except that circulating ACTH would be low because of negative feedback suppression at both hypothalamic CRF and anterior pituitary levels ACTH. Addisons Disease is caused by glucocoicoid deficiency, not excess. Hypophysectomy would lead to a decrease in ACTH or remove the source of it. 