Question

A $34$-year-old woman is referred to the endocrinology clinic due to unexplained weight gain of $15$ kg over the past year, accompanied by easy bruising and new-onset facial hair growth. She reports that her menstrual periods, previously regular, now occur only once every $3$ to $4$ months. Vital signs show a blood pressure of $158/98$ mm Hg. Physical examination is notable for facial plethora, a dorsocervical fat pad, truncal obesity with thin extremities, and wide, purplish striae over the lower abdomen and flanks. The physician suspects hypercortisolism. Assuming the patient ultimately has a pituitary adenoma (Cushing disease) and each successive diagnostic test dictates the need for further localization, arrange the following laboratory tests and diagnostic procedures in the correct sequential order from initial screening to definitive confirmation.