N518 Group Case Study History of Present Illness: M.K. is a 35-year-old Caucasian woman who presents to her PCP complaining of a dull but persistent headache, a significant weight gain over the past six weeks, significant facial hair growth, menstrual abnormalities, and both an excessive thirst and appetite. She also feels very depressed, does not have much energy, and has stopped performing all the activities that she had’ previously enjoyed (tennis, bridge, and shopping for new clothes). M.K. is married, has an adolescent son (age 16) and daughter (age 13) and has been in relatively good health throughout her life. She is: the third oldest of four children. One of her brothers was diag-nosed with type I diabetes mellitus at age 11 and was recently evaluated for hypertension. Her two sisters are in good health. Her father is a cancer survivor of childhood leukemia and her mother has a history of rheumatoid arthritis and breast cancer. The patient does not smoke and only consurnes alcohol in moderation at social funs- Lions. She has several allergies (ragweed and cat: dander) and is not taking any medications other than a daily multivitamin tablet and ibuprofen (as needed) for headache.Physical Exam and Laboratory Tests:The patient is an alert but anxious, moderately overweight white female with a noticeably round, full face, T =98.3°F orally; P = 85 beats/min and regular; RR -14 breaths/min and unlabored; BP = 185/105 rim Hg left arm, sitting;• lit = 5 0 ; Wt = 141 lbs. HEENT, Skin, Neck• Head exam normal except for significant facial hair growth • Fundi without lesions, PERRLA • Nares, tympanic membranes, and pharynx clear • Skin appears hypeipigmented and thin with SOITle bruising on the arms and hands • Gingiva show localized areas of hyperpigmentation Neck supple • • No bruits • Fat deposits in dorsocervical region • Thyroid non-palpable No palpable cervical, supracla.vicular, infraclavicular, or axillary ad’enopathyLungs, CardiacExams unremarkableAbdomen
Protuberant with striae and minimal bruising • Bowel sounds heard in all four quadrants • No abdominal bruits, masses, tenderness, or organomegaiy
