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Rosemary's hyperglycemia cannot be attributed to diabetes mellitus because insulin activity is normal, as indicated by the glucose tolerance test. The symptoms might be due to hyperthyroidism, but this possibility is ruled out by the blood tests. The high blood levels of corticosteroids are not the result of ingestion of these compounds as drugs. However, the patient might have Cushing's syndrome, in which case an adrenal tumor could be responsible for the hypersecretion of corticosteroids and, as a result of negative feedback inhibition, a decrease in blood ACTH levels. This possibility is supported by Rosemary's low ACTH levels. Excessive corticosteroid levels cause the mobilization of glucose from the liver, thus increasing the blood glucose to hy-perglycemic levels.

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