A case of idiopathic Cushings disease
Idiopathic Cushings disease
Imama
17 YEAR OLD BOY PRESENTED WITH ABDOMINAL DISTENSION AND WEIGHT GAIN
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17 year old boy presented to the OPD on 24/11/21 at 11:48 a.m with chief complain of
- Itchy ring lesion over upper limb , lower limb , abdomen , lower back and thigh since 1 year
- abdominal distension since 6 months
- facial puffiness since 6 months
- pedal edema since 3 month
- lower back pain since 3 months
- low mood and refusing to meet anyone
History of Presenting Illness
Patient was apparently asymptomatic 1 year ago after which he gradually developed erythematous round lesion which are itchy and distributed all over upper limb , groin region , abdomen and inner thigh .
The lesion were aggrevated whenever the patient go out in hot sunny climate and patient get burning sensation on scratching .
Patient is constantly depressed and has low mood . Patient attender is complaining that the patient is not going out of house and is staying in home constantly . On asking about it patient says he feels bad about his appearance .
Features of hirsutism and decreased libido.
Past History
- weight gain since 6 months ( from 63 kg to 74 kg )
- Patient visited local RMP where he was prescribed some herbal medicine which he had taken for 6 months .
Patient started noticing pink striae over his abdomen and later on back and over arms which gradually increased in size .
There was increase in size of striae over abdomen since 1 month .
He also observed abdominal distension , facial puffiness , weight gain and pedal edema with associated low back pain since 3 months .
Patient was advised to consult dermatologist .
The dermatologist diagnosed it as a case of Tinea cruris et corporis + Striae Rubra and started medication as such .
LULIFIN CREAM OD * 2 weeks
EBERNET PLUS CREAM L/A OD * 2 weeks
TAB SEBIFIN 250 mg OD * 2 weeks
T - BACT OINTMENT L/A B/O * 1 week
TAB ATARAX 25 mg OD * 5 days
- Known case of HTN
On T. TELMA AM 40 mg Po/OD
Personal History
Mixed diet
Normal appetite
Ball and bladder movement regular
Normal micturition - no burning sensation
No known allergies
No addiction
General Examination
Pallor - absent
Icterus - absent
No cyanosis
No clubbing
No lymphadenopathy
Pedal edema present ( non pitting type )
Temp. - 97.8 F
Pulse rate - 78/min
Respiratory rate - 17 cpm
BP - 140/90
SPO2 - 99 per cent
GRBS - 108 mg
CVS - S1,S2 heard
RS - BAE + , NVBS heard
Per Abdomen - distended abdomen
- Soft , non-tender
- Liver and spleen non palpable
- Superficial vein seen on abdomen
** Superficial vein on Abdomen indicate skin atrophy which is classical of Cushing syndrome
INVESTIGATIONS
Clinical images
Provisional Diagnosis
Iatrogenic Cushing Syndrome
Adrenal insufficiency ??
Tinea Corporis and Cruris
Treatment
Salt restricted diet
Carbohydrate restricted diet
T. TELMA AM 40/5 mg / PO / OD
T. ATARAX 25 mg PO/OD * 5 days
T. SEBIFIN 250 mg PO/OD * 2 weeks
EBERNET PLUS CREAM L/A OD * 2 weeks
T - BACT OINTMENT L/A BD * 2 weeks
LULIFIN CREAM L/A OD * 2 weeks
Inj. HYDROCORTISONE 100 mg i.v ( only if patient is in shock , hypotension, hypoglycemia )
T. SHELCAL 500 mg PO/OD
T . METFORMIN 500 mg PO/OD stopped
T. NICARDIA 10 mg /SOS
IATROGENIC CUSHING SYNDROME
ADRENAL INSUFFICIENCY ??
known case of HTN
Tinea Corporis and Cruris
I would like to thank intern ma'am for giving me an opportunity to go through this case .
posted by Imama Muhmeen 163 @ December 14, 2021
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