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 

             done 24/11/21

            donee 23/11/21

         ECG reps

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 

Patient was referred to ophthalmologist for visual acuity testing and fundoscopy for raised IOP

medication chart

Fever chart

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 .