Underlying

Endocrine System


0

{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M73_F1.jpg"}},{"insert":"\n\nYou\u0027ve had a relatively slow day in the medical clinic. So far, all of your patients have been routine follow-ups for diabetes, hypertension, and dyslipidemia \u2013 hardly challenging work.\n\nYour nurse ushers the next patient in: 47-year-old Ivy Cole. She\u0027s new to your practice, having moved into your town just a couple of weeks ago.\n"}]}

1

{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M73_F2.jpg"}},{"insert":"\n\nYou introduce yourself and ask Ivy what her problem is. \u0022Oh doctor \u2013 I\u0027ve got this headache that just comes and goes,\u0022 she says. \n\nYou learn that the headache occurs several times a day, with each episode ranging from a few minutes to as long as half an hour. The headache is generalized. On a pain scale of 1 to 10 (with higher values indicating more pain) she rates it a 6. There are no obvious aggravating or relieving factors. Neither are there associated symptoms such as tearing or disturbances with vision.\n\nIvy was diagnosed with type II diabetes mellitus around 12 months ago. She was started on oral metformin 500mg bd around 9 months ago, as dietary measures and exercise proved to be insufficient for control. She was poorly compliant with her medication and defaulted on follow-up around 6 months ago (\u0022I was laid-off and lost my health insurance,\u0022 she confides). She has no other known comorbidities. She has put on around 8kg in weight over the last year, which she attributes to stress-related overeating after losing her job.\n\nIvy is post-menopausal. Her menarche was at 12 years of age and menopause at 42 years of age. She has one grown-up child (\u0022had him young, doctor!\u0022 she says). She lives alone, and is separated from her husband. She is currently employed as the assistant manager of a nearby department store.\n"}]}

2

{"ops":[{"insert":"You ask Ivy if she has any other symptoms at all \u2013 no matter how small or insignificant.\n\n\u0022Well, doctor \u2013 this might sound silly, but I could swear that my voice has changed over the last few months. I can\u0027t seem to hit the high notes when singing in the church choir,\u0022 she responds.\n\nFurther questioning reveals that she has not had an upper respiratory tract infections recently; and that she has not engaged in any activities that might put a strain on her vocal cords.\n\n\u0022I\u0027m a manager \u2013 but not that kind of manager!\u0022 Ivy jokes.\n"}]}

3

{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M73_F4.jpg"}},{"insert":"\n\nYou proceed to examine Ivy. Her BMI is 32.0. All vitals are within normal parameters.\n\nIn the general examination, you note prognathism and thickening of both brow ridges, nose, and both ear lobes. There is obvious macroglossia with increased dental spacing. Both hands appear slightly swollen. There is increased terminal hair over both forearms and shins.\n\nCardiorespiratory, abdominal, and CNS examination are all unremarkable.\n"}]}

4

{"ops":[{"insert":"Now that the history-taking and examination are over, you ponder what the likely diagnosis might be.\n\nWhich of the following are you thinking of?\n"}]}
1. Acromegaly
2. Hypothyroidism
3. Polycystic ovarian syndrome

8

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7

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6

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5

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