A 45-year-old patient presents with weight gain and features suggestive of hormonal imbalance. Which condition is most likely responsible for these symptoms?

• A. Cushing's syndrome
• B. Hypothyroidism
• C. Hyperaldosteronism
• D. Addison's disease

Answer: (A)

Cushing's syndrome is suggested when weight gain comes with signs of cortisol excess that change fat distribution and metabolism. Excess cortisol promotes glucose production and insulin resistance, increases appetite, and shifts fat to the trunk, face, and the back of the neck, producing central obesity, a rounded face, and a dorsocervical fat pad. Skin changes, easy bruising, and hypertension often accompany these features, reinforcing the cortisol-dominant picture.

Hypothyroidism can cause weight gain but typically lacks the specific fat redistribution and skin/stretch mark pattern seen with Cushing's. Addison's disease generally leads to weight loss and low blood pressure rather than weight gain. Hyperaldosteronism mainly causes hypertension and electrolyte disturbances rather than broad weight gain.

So, the combination of weight gain with the characteristic hormonal imbalance signs points to Cushing's syndrome as the best explanation.