So What’s Wrong With This Patient? – #1
The medical field is full of variety and complexity. From the simplest of disorders to the most complex diseases, you will be hard pressed to find a dull moment as a healthcare provider.
Over the past year of training to become a paramedic, I have had the fortunate opportunity to come across various different patients with a multitude of complaints, allowing me to muster my skills of patient assessment and physical examination in order to determine the root cause of the clinical problems.
I would like to take this opportunity and invite you all to recognize the intricacies of medical disorders and how to manage them on an emergent basis. Over the last several weeks, I have been going over some of the classic patient cases that I have come across in my short career as a part of the medical field. While the encounters have been momentary, they have left a deep impact on my learning and outlook towards this noble profession.
So what are we waiting for? Let the problem solving continue on! We will conclude with our last case here at #1.
1. The Mysterious Diagnosis
History of Present Illness: Patient is a 34-year-old male who calls EMS with a chief complaint of fatigue and not feeling too well for the past several days.
Physical Examination: On further questioning, the patient reports difficulties with proper cognition, anxiety, loss of emotional control, and weight gain. Physical findings include marked fatty tissue deposits ON the face and on the upper back between the shoulders. Stretch marks are also seen on the abdomen and arms along with acne in the facial region.
Patient does not have any drug allergies and has been recently started on Lisinopril for hypertension. Patient has no pertinent past medical history.
So what’s the diagnosis and treatment? (Here’s a hint!)
Answer: Cushing’s Syndrome
Cushing’s syndrome is a condition where increasing levels of cortisol are present in the body. Cortisol is an endogenous hormone that is usually released from the adrenal cortex under conditions of high stress. Either due to excessive consumption of cortisol through external sources (such as corticosteroids) or through pathological mechanisms at the level of the pituitary gland and adrenal gland, the body has a higher than normal level of this hormone, resulting in the classic symptoms depicted in the case above. Fatty tissue deposits in the facial (moon face) and shoulder (buffalo hump) regions are two of the most well known features of Cushing’s syndrome.
If left untreated, this condition can lead to complications such as hypertension, diabetes, muscle loss, and bone loss. In the emergent setting, treatment is primarily directed at providing supportive care. Consultation with an endocrinologist will likely be recommended in the hospital setting in order to control and resolve the ailment. However, given its rare nature, it is important to keep a high index of suspicion for endocrine conditions in our medical assessments.
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