History and Physical Exam

History

A 27-year-old woman presents with depression, insomnia, increased facial fullness and recent increase in facial hair. She had also had an episode of depression and acute psychosis following uncomplicated delivery of normal baby boy 9 months previously. Her menses have been irregular since their resumption after the birth (she is not breast-feeding).

Physical Exam

The heart rate was 90 beats per minute and the blood pressure was 146/110. Her face was puffy with an increase in facial hair and ruddy complexion. There was no truncal obesity, peripheral wasting, or striae.

Routine Labs

Serum electrolytes, white cell count, and hemoglobin and hematocrit were all within normal limits.

Questions

  1. What do you think the patient's primary problem is?
  2. What laboratory tests would you order to evaluate this patient?