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Pituitary Case: 48-year-old Woman with Weight Gain, Easy Bruising, and Hypertension
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Slides 01-02-01 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
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 shows 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. She has 24-hour free cortisol of 200 g/24 h, midnight salivary cortisol of 300 ng/mL, and an ACTH level of <5 pg/mL. What is the most likely diagnosis for the patient?
- 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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