Soru

A $27$-year-old woman comes to the clinic for evaluation of profound fatigue, proximal muscle weakness, and progressive facial hair growth over the past $14$ months. Her menstrual periods occur only once every $3$ to $4$ months. She also reports severe mood swings. Three months ago, a different physician started her on fluoxetine monotherapy for depression; shortly after, she experienced a $10$-day period of rapid speech, grandiosity, and a decreased need for sleep before returning to a depressed state.

She brings laboratory results from an outside wellness clinic. They performed a novel serum biomarker test for 'adrenal malignancies.' The test has a sensitivity of $90\%$ and a specificity of $90\%$. The prevalence of adrenal malignancy in her age group is $1\%$. The test result was positive, and she is terrified that she has cancer.

Vital signs are temperature $36.8^\circ\text{C}$ ($98.2^\circ\text{F}$), blood pressure $155/96$ mmHg, pulse $82$/min, and BMI $34 \text{ kg/m}^2$. Physical examination reveals a plethoric face, prominent coarse hair on the chin, and multiple $2$-cm wide violaceous striae on the lower abdomen.

Laboratory results:
TSH: $2.1 \text{ \mu U/mL}$ (Normal: $0.5 - 5.0 \text{ \mu U/mL}$)
Free T4: $0.5 \text{ ng/dL}$ (Normal: $0.9 - 1.7 \text{ ng/dL}$)
Testosterone, total: $95 \text{ ng/dL}$ (Normal: $15 - 70 \text{ ng/dL}$)

Which of the following is the most appropriate next step in the evaluation or management of this patient?