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    DR B Helmy Sheets Cushing

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    zizo
    This document summarizes a case study of a 40-year-old female patient who presented with progressive weight gain over 3 years. She had a history of systemic lupus erythematosus 9 years prior and was diagnosed with hypertension and diabetes 3 years ago. On examination, she exhibited features of Cushing's syndrome including central obesity, purple stretch marks, muscle weakness, and low bone density. Laboratory tests showed abnormal cortisol levels and imaging found a pituitary tumor, leading to a diagnosis of Cushing's disease, a condition caused by excessive cortisol secretion from the pituitary gland.

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    DR B Helmy Sheets Cushing

    Uploaded by

    zizo
    33 views2 pages
    This document summarizes a case study of a 40-year-old female patient who presented with progressive weight gain over 3 years. She had a history of systemic lupus erythematosus 9 years prior and was diagnosed with hypertension and diabetes 3 years ago. On examination, she exhibited features of Cushing's syndrome including central obesity, purple stretch marks, muscle weakness, and low bone density. Laboratory tests showed abnormal cortisol levels and imaging found a pituitary tumor, leading to a diagnosis of Cushing's disease, a condition caused by excessive cortisol secretion from the pituitary gland.

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    Dr.B.Helmy.Sheets.Cushing

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    This document summarizes a case study of a 40-year-old female patient who presented with progressive weight gain over 3 years. She had a history of systemic lupus erythematosus 9 years prior and was diagnosed with hypertension and diabetes 3 years ago. On examination, she exhibited features of Cushing's syndrome including central obesity, purple stretch marks, muscle weakness, and low bone density. Laboratory tests showed abnormal cortisol levels and imaging found a pituitary tumor, leading to a diagnosis of Cushing's disease, a condition caused by excessive cortisol secretion from the pituitary gland.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    33 views2 pages

    DR B Helmy Sheets Cushing

    Uploaded by

    zizo
    This document summarizes a case study of a 40-year-old female patient who presented with progressive weight gain over 3 years. She had a history of systemic lupus erythematosus 9 years prior and was diagnosed with hypertension and diabetes 3 years ago. On examination, she exhibited features of Cushing's syndrome including central obesity, purple stretch marks, muscle weakness, and low bone density. Laboratory tests showed abnormal cortisol levels and imaging found a pituitary tumor, leading to a diagnosis of Cushing's disease, a condition caused by excessive cortisol secretion from the pituitary gland.

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    © All Rights Reserved
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    of 2

    Sheets

    ٍ B.H.

    Cushing Disease
     Personal history
    ‫ رـ
    ـد‬female pt, 40 years old, from ‫ !ـ ا اـ‬, married and has 4 off springs, no
    special habit of medical importance.

     c/o
    Progressive weight gain of 3 years duration.

     HPI
    The condition started 9 years ago by skin rash at face, loss of hair, dyspnea,
    odema of L.Ls then the patient sought medical advice and investigated and diagnosed as a
    systemic lupus erythematosis and treated by cortisone.

    3 years later, she experienced headache, blurred vision, tinnitus associated with
    polyphagia, polyuria, polydypsia. The patient sought medical advice and investigated,
    then diagnosed as HPN, DM and took medical ttt in the form of capozide, glucophage .
    The patient complained of gradual onset, progressive course of increased body
    weight in last 3 years.
    The patient also gives history of generalized bony pain and difficulty in lifting
    heavy objects and tingling and numbness in both hands and feet also increased in the
    last 3 years of her story.
    No symptoms suggesting cardiovascular system affection
    No menstrual troubles
    No symptoms suggesting pulmonary T.B
    No history of abdominal swellings

     Past history
    No drugs, operation, disease (DM, HPN).

     Family history
    - No consanguinity.
    - No similar condition in family.
    - No common disease in family.

     General exam
    - Temperature: 37o c.
    - Bl. Pressure: 160/90(with TTT).
    - Pulse: Regular, 70 beat/minute, average volume, no special character, equal in both
    sides, intact peripheral pulsation, vessel wall is not felt, no radio-femoral delay.
    - Built: Central Obesity.
    - Head: Moon face, acne vulgaris (was), hirsutism (was), plethoric face,loose teeth,
    decreases acuity of vision.
    - Neck: buffalo hump, supra-clavicular pads of fat.
    - Mentality: The patient is fully conscious, well oriented for time, place and person.
    Average mood and memory. The patient is co-operative with average intelligence.
    Sheets
    ٍ B.H.

     Other Systems
    - Skin: thin, stria rubra, no pigmentation, no diabetic skin changes, no purpura, no
    acne or hirsuitism.
    - Cardio: search for signs of HTN and HF (cardio)
    - Bone: there is generalized bony tenderness and crepitus with joint movements.
    - Neuromuscular: search for myopathy, neuropathy (Neuro).
    - Chest : search for T.B(chest)
    - Abdomen: no mass in renal angle (adrenal), No masses in abdomen by inspection,
    palpation (ovarian masses, paramalignant).

     Investigation
    Investigation to suspect case:
    - CBC: ↑ RBCs, ↓ oesinophil, lymphocyte
    - Blood level of :↑ NA, ↓ k, ↑ Bl. Glucose.

    - Level of cortisol at morning (8 am) at night (11pm).


    - Level of 17OH CS in urine, free cortisol.
    - Overnight dexamethasone suppression test.
    - U.S, x-ray abdomen.
    - CT, x-ray, MRI skull.

     Treatment
    Stop exogenous cortisol gradually or try to moderate the dose to the lowest effective
    dose.

     Diagnosis :

    A case of obesity + HTN+ DM for D.D most probably cushinoid .

     Central obesity
     Purpura
     Stria rubra
     Myopathy
     Osteoporosis
    : ‫ن‬/0123 4256‫أ‬ 
    TU‫ ا‬- QRS‫ازن – ا‬

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