A 56-year-old female with past medical history of diabetes mellitus type 2 presents with a rash on the region of her axilla. See picture:
This rash is known as what?
Correct Answer D: Acanthosis nigricans is most commonly caused by insulin resistance, usually from type 2 diabetes mellitus.
Other causes are:
In the context of a malignant disease, Acanthosis nigricans is a paraneoplastic syndrome and is then commonly referred to as Acanthosis nigricans maligna. Acanthosis nigricans should make you suspicious for a malignancy.
People with acanthosis nigricans should be screened for diabetes and, although rare, cancer. Controlling blood glucose levels through exercise and diet often improves symptoms.
In Cushing syndrome you find all, except:
Correct Answer A: Cushings syndrome is one of the secondary causes of hypertension. Therefore the blood pressure would be high. Along with Cushings, the other causes include Hyperaldosteronism, Aortic coarctation, Pheochromocytoma and Stenosis of renal artery. Remember the mnemonic C.H.A.P.S. for these 5 causes of secondary hypertension.
What is the diagnostic test of choice to confirm Cushing syndrome?
Correct Answer B: Cushing's syndrome is a constellation of clinical abnormalities caused by chronic high blood levels of cortisol or related corticosteroids. Cushing's disease is Cushing's syndrome that results from excess pituitary production of ACTH, usually secondary to a pituitary adenoma. Typical symptoms include moon facies and truncal obesity with thin arms and legs. Diagnosis is by history of receiving corticosteroids or by elevated serum cortisol.
Diagnosis is confirmed with the dexamethasone test, in which 1, 1.5, or 2 mg of dexamethasone is administered po at 11 to 12 pm and plasma cortisol is measured at 8 to 9 am the next morning. In most normal patients, this drug suppresses morning plasma cortisol to ≤ 1.8 µg/mL (≤ 50 nmol/L), whereas patients with Cushing's syndrome virtually always have a higher level. A more specific but equally sensitive test is to give dexamethasone 0.5 mg po q 6 h for 2 days (low dose). In general, a clear failure to suppress levels in response to low-dose dexamethasone establishes the diagnosis.
A 52-year-old woman, recently diagnosed with hypertension, presents to her family physician complaining of hirsutism and acne. Laboratory examination reveals:
Which one of the following is the most likely diagnosis?
Correct Answer B: In Cushing's syndrome, the level of corticosteroids is excessive, usually from overproduction by the adrenal glands. Corticosteroids alter the amount and distribution of body fat. Excessive fat develops throughout the torso and may be particularly noticeable at the top of the back. A person with Cushing's syndrome usually has a large, round face (moon face). The arms and legs are usually slender in proportion to the thickened trunk. Muscles lose their bulk, leading to weakness.
High corticosteroid levels over time raise the blood pressure, weaken bones (osteoporosis), and diminish resistance to infections. The risk of developing kidney stones and diabetes is increased, and mental disturbances, including depression and hallucinations, may occur. Women usually have an irregular menstrual cycle. Children with Cushing's syndrome grow slowly and remain short. In some people, the adrenal glands also produce large amounts of androgens (testosterone and similar hormones), leading to increased facial and body hair in women and balding.
When Cushing's syndrome is suspected one should measure the level of cortisol, the main corticosteroid hormone, in the blood. Normally, cortisol levels are high in the morning and lower late in the day. In people who have Cushing's syndrome, cortisol levels are very high throughout the day.
All the following can be given to improve sexual function in males, except:
Correct Answer B: Sexual dysfunction in males can be treated with various drugs. Viagra (sildenafil) (choice A) is a popular choice for erectile dysfunction (ED). Testosterone (choice C) is used as it promotes and maintains secondary sex characteristics in androgen-deficient males. Gonadotropin-releasing hormones (choice D) have been used in patients with GonadotropinReleasing Hormone Deficiency because these patients can develop hypogonadism leading to infertility and sexual dysfunction.
Estrogen (choice B) has no role in the treatment of male sexual dysfunction, but in females estrogen creams are used for atrophic vaginitis in the elderly.
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