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Med Surg Case Study #9

Presenting Complaint: Jane, a 35-year-old female, presents to the clinic complaining of weight gain, particularly in the face, abdomen, and upper back over the past few months. She reports easy bruising, irregular menstrual periods, excessive hair growth on her face, and muscle weakness. Jane mentions feeling fatigued despite adequate sleep and experiencing frequent headaches. She denies any recent illness or significant changes in her lifestyle.

Patient Background: Jane has a history of asthma for which she intermittently uses an inhaler. She denies any other chronic medical conditions and reports no significant family history of endocrine disorders. Her current medications include only her asthma inhaler. She works as an accountant and leads a relatively sedentary lifestyle. She denies smoking or alcohol use.

Assessment: Upon physical assessment, Jane appears overweight with a rounded face (moon face), prominent supraclavicular and dorsal fat pads, and abdominal striae. Her blood pressure is slightly elevated. Laboratory findings reveal elevated cortisol levels on multiple measurements throughout the day. Further investigation reveals an elevated ACTH (adrenocorticotropic hormone) level.

1. Based on Jane's history and assessment findings, what is the possible diagnosis for his condition?

2. What diagnostics might be used to confirm the diagnosis?

3. What treatments might be needed for Jane's condition?

See answers below

Med Surg Notebook


1. What are the possible diagnoses for Janes's condition?

The possible diagnosis for Mr. Janes's condition is Cushing's Syndrome, specifically, an endogenous form due to increased ACTH secretion, possibly caused by an ACTH-secreting pituitary adenoma (Cushing's disease) or ectopic ACTH production from another source, like a tumor elsewhere in the body.

2. What diagnostics might be used to confirm the diagnosis?

Diagnostic tests:

  • 24-hour urinary free cortisol test

  • Overnight dexamethasone suppression test

  • Measurement of late-night salivary cortisol

  • Imaging studies such as MRI or CT scans to locate potential tumors in the pituitary or elsewhere in the body causing the increased ACTH production.

3. What treatments might be needed for Jane's condition?

The treatments would depend on its cause. Possible treatments may include surgical intervention (possible pituitary adenomas causing Cushing's disease). Surgical removal of the tumor if an ectopic source is identified. Also, radiation therapy or medications (e.g., ketoconazole, metyrapone) if surgery is not an option or as a pre-operative treatment to reduce cortisol levels. Lifestyle modifications: dietary changes, exercise, stress reduction.

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