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EM@3AM: Cushing’s Syndrome

A 60-year-old female with diabetes and hypertension from skilled nursing facility presents with worsening mental status, shortness of breath, and muscle weakness. Vital signs include BP 175/100, HR 105, RR 22, SpO2 95% on room air, T 100.7F, and blood glucose of 275. Physical exam is remarkable for A&Ox2, obesity, striae, bilateral upper/lower extremity muscle weakness, and 2+ bilateral lower extremity edema. CMP/CBC is unremarkable, BNP is 250, and EKG shows low voltage. Outpatient random serum cortisol is 2700 nmol/L. What is the diagnosis, and urgent interventions will reduce the patient’s morbidity/mortality?