A 34-Year-Old, Previously Healthy Woman Comes to the Office Due

A 34-year-old, previously healthy woman comes to the office due to irregular menstruation and a 4.5 kg (10-lb) weight gain over the past 6 months.  The patient also reports muscle weakness causing difficulty climbing stairs or lifting her child.  Blood pressure is 152/86 mm Hg and pulse is 72/min.  BMI is 31 kg/m².  Laboratory studies reveal an elevated serum cortisol level that is not suppressed following administration of low-dose dexamethasone.  Her 24-hour urine free-cortisol concentration and plasma ACTH are elevated.  Which of the following histopathologic findings are most likely to be present in this patient's adrenal glands?

A) Adenoma of the zona glomerulosa
B) Atrophy of all layers of the adrenal cortex
C) Hyperplasia of the adrenal medulla
D) Hyperplasia of the zona fasciculata and reticularis
E) Neoplasia of adrenal medulla