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Pituitary Case: 48-year-old Woman with Weight Gain, Easy Bruising, and Hypertension
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Slides Adrenal-Pituitary.pdf
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Download Lecture Overview
00:01 Let's discuss another case. 00:03 A 48-year old woman is seen for weight gain, easy bruising, hypertension, and worsening diabetes control. 00:11 She takes metformin and lisinopril. 00:14 On exam, she has a blood pressure of 172 over 90, a heart rate of 77 beats per minute, and a BMI of 35. 00:24 She has centripetal obesity with livid stria, a supraclavicular and posterior neck fat pad, as well as hirsutism on her chin and anterior neck. 00:36 Her labs show 24-hour free cortisol of 200 micrograms in 24 hours, a midnight salivary cortisol of 300 nanograms per ml, and an ACTH level of less than five picograms per ml. 00:52 What is the diagnosis? In reviewing this fairly complex presentation, there are some signs and symptoms that are worth noting. 01:01 First of all, these signs and symptoms suggest cortisol excess. 01:05 This is manifested as weight gain, bruising, hypoglycemia, hypertension, centripetal wall fat distribution, the presence of stria, and hirsutism. 01:17 Also, the labs show increased cortisol and a suppressed ACTH. 01:22 This woman clearly has Cushing syndrome.
About the Lecture
The lecture Pituitary Case: 48-year-old Woman with Weight Gain, Easy Bruising, and Hypertension by Michael Lazarus, MD is from the course Pituitary and Hypothalamic Disorders.
Included Quiz Questions
What is the most likely diagnosis for the patient in the case below? A 48-year-old woman presents with complaints of weight gain, easy bruising, hypertension, and worsening diabetes control. She takes metformin and lisinopril. Physical examination: Blood pressure of 172/90 mm Hg, heart rate of 77 beats/min, and BMI of 35 kg/m2. She has centripetal obesity with livid striae, supraclavicular and posterior neck fat pads, and hirsutism on the chin and anterior neck. Laboratory test results: 24-hour free cortisol of 200 g/24 h, midnight salivary cortisol of 300 ng/mL, and ACTH level of <5 pg/mL.
- Cushing syndrome
- ACTH-secreting pituitary adenoma
- Prolactinoma
- Polycystic ovary syndrome
- Fatty liver disease attributable to diabetes
Author of lecture Pituitary Case: 48-year-old Woman with Weight Gain, Easy Bruising, and Hypertension
Michael Lazarus, MD
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