What condition is indicated by a 24-hour urine collection for cortisol that is markedly elevated, along with hypertension and purple striae?

The presented symptoms of markedly elevated 24-hour urine cortisol, hypertension, and purple striae are characteristic of Cushing's syndrome. Cushing's syndrome is caused by excess cortisol in the body, which can occur due to various factors such as an adrenal tumor, pituitary adenoma (Cushing's disease), or ectopic ACTH production.

In this condition, elevated cortisol levels lead to a range of clinical features. Hypertension is common due to the glucocorticoid effects on vascular tone and volume. The presence of purple striae arises from skin changes related to collagen breakdown and changes in skin elasticity associated with prolonged exposure to high levels of cortisol. The striae are often wider and darker compared to those caused by typical weight gain or pregnancy.

The other conditions listed do not present with this specific combination of symptoms. For example, hyperaldosteronism mainly leads to hypertension and hypokalemia but does not typically cause elevated cortisol levels or the characteristic striae. Hypopituitarism leads to a deficiency of multiple hormones and would not be associated with elevated cortisol. Acromegaly results from excess growth hormone and typically does not feature elevated cortisol or purple striae as key indicators. Thus, the clinical picture strongly points to Cushing