A 42-year-old woman presents to your office complaining of several months of weight gain, menstrual irregularity, increased urination and increased abdominal girth. A detailed review of systems reveal irritability, insomnia, mood changes, difficulty standing up from a seated position, difficulty climbing stairs, and blurry vision. She is also distressed because of grown hair on her chin. Her only current medication is naproxen for menstrual-related pains. While speaking with her, you note that she has moon facies and increased fat pads on the back of her neck. Her temperature is 98.2 °F, heart rate is 89 beats/min, blood pressure is 168/99 mm Hg, respirations are 19 breaths/min, and oxygen saturation is 97% on room air. On examination, she is obese, with a plethoric appearance. Her abdomen is obese. Her arms and legs are thin. There is muscle wasting. There are prominent purplish striae over the abdomen. There are multiple bruises over both lower legs. Which of the following is the next step in the management of this patient?
