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Cushing's Disease: Weight Gain, Weakness, and Menstrual Abnormality

This case study describes a 33-year-old woman with symptoms of Cushing's disease, including weight gain, weakness, menstrual abnormalities, easy bruising, hirsutism, headaches, and psychiatric symptoms.

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Cushing's Disease: Weight Gain, Weakness, and Menstrual Abnormality

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  1. a 33 y/o woman with symptom of cushing disease.

  2. Cc: weight gain

  3. PI: The patient is a 33 y/o woman with significant weight gain from 1 year ago (18 kg ), generalized weakness and muscle weakness, menstrual abnormality(first oligomenorrhea then amenorrhea), easy bruising, hirsutism, unilateral headach and gradually psychiatric demonstration.

  4. PI: The patient was worked up with suspicion of cushing. UFC, LDDST and HDDST were done. Cushing was confirmed but MRI was not diagnostic. She was treated by Tab ketoconazole 200mg BDfor 9 monthes then IPSS was done and hypophysialcushing was confirmed then TSS was done.

  5. PMH:neg DH:neg FH: Father:IHD, mother: DM II, HTN HH:neg SH: tonsillectomy at 06.95

  6. ROS: Negative: achnea, nausea, vomiting, myalgia, paresthesia,bone pain, vertigo, memory loss, abdominal pain,constipation, diarrhea, galactorrhea, loss of appetite

  7. PE: The patient s a 32 y/o woman who is oriented and cooperative. non ill and non toxic. Vital sign: BP: 120/70 HR:70 T:36.5 RR:14 Wt:92 Ht: 176 BMI:29.7 waist:110 Head and neck: Moon face, no preorbital edema cranial nerve normal hirsutism(chin 2+ , behind the lips 2+ ) Thyroid:NL LAP: -

  8. Skin: dry • Lung: normal • Heart: normal • Abdomen: normal (no distention, mass or tenderness) • Extermities: force(prox and distal):5/5 , pulse:full and symmetric , bone tenderness:- , sensory: normal • Breast exam:normal • Neurologic: DTR(2+ symmetric), cranial nerve: normal

  9. Problem list: • Weight gain, • hirsutism, • easy bruising, • moon face, • menstrual abnormality, • weakness

  10. MRI 20/03/96

  11. MRI 03/12/96

  12. At 12.11.96 ►►► IPSS ►►►Cushing(hypophysis adenoma) • At 11.12.96►►► TSS►►►CSF leak and polyuria • and polydipsia►►► re operate

  13. Brain CT of the day after surgery

  14. She took Tab prednisolone 50 mg daily from 11.12.96 for 2 weeks then Tab hydrocortisone 15 mg till 01.02.97 Spry DDAVP from 27.12.96 till now.

  15. From 03.01.97 till 08.01.97 she admitted to hospital due to fever, headache and sore throat • She was treated with antibiotic with a diagnosis of sinusitis.

  16. با سپاس فراوان

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