Case study:
Patient:
- Name: Sarah Johnson
- Age: 32 years
- Gender: Female
- Occupation: Marketing Manager
- Chief Complaint: Rapid weight gain, facial rounding, and mood swings over the past year.
Presenting Symptoms:
- Sarah initially sought medical attention due to a significant and rapid weight gain of 30 pounds over the past year. She mentioned that most of the weight was concentrated in her abdomen, and she was unable to lose it despite dieting and exercise.
- She also reported the development of a moon-shaped face, with noticeable facial rounding and red-purple stretch marks on her abdomen and thighs.
- Sarah had been experiencing muscle weakness, fatigue, and easy bruising, which she attributed to her sedentary job and weight gain.
- She complained of irregular menstrual periods for the past six months, which had not been an issue previously.
- Her blood pressure was consistently elevated, with readings averaging 150/90 mm Hg.
Medical History:
- Sarah had a history of asthma but was otherwise healthy before the onset of her symptoms.
- She denied any use of corticosteroid medications, either orally or topically.
- She mentioned feeling increasingly irritable and anxious, which had started to affect her work and personal relationships.
Physical Examination:
- Physical examination revealed a moon-shaped face with facial rounding.
- Sarah had prominent red-purple stretch marks (striae) on her abdomen and inner thighs.
- Her blood pressure was elevated, with an average reading of 150/90 mm Hg.
- Muscle strength testing showed mild proximal muscle weakness, particularly in her thighs and shoulders.
- Laboratory tests revealed elevated serum cortisol levels, with a 24-hour urine cortisol test confirming excessive cortisol excretion.
- A low-dose dexamethasone suppression test indicated a lack of cortisol suppression.
Diagnostic Workup:
- Further investigations included imaging studies, such as magnetic resonance imaging (MRI) of the brain and computed tomography (CT) of the adrenal glands.
- Brain MRI revealed a pituitary adenoma measuring 8 mm in diameter.
- CT of the adrenal glands showed no abnormalities.
Diagnosis:
- Based on the clinical presentation, laboratory findings, and imaging results, Sarah was diagnosed with Cushing’s syndrome due to a pituitary adenoma, specifically Cushing’s disease.
Treatment:
- Sarah was referred to a neurosurgeon for evaluation and treatment of the pituitary adenoma.
- She underwent transsphenoidal surgery to remove the tumor, which was successful in achieving tumor resection.
- After surgery, her cortisol levels gradually normalized, and her symptoms, including the moon face and abdominal striae, began to improve.
- She required close monitoring of her hormone levels and blood pressure, as well as follow-up imaging studies, to ensure the adenoma did not recur.
Outcome:
- Throughout several months post-surgery, Sarah’s weight gradually decreased, and her menstrual cycle returned to normal.
- Her blood pressure normalized, and her muscle weakness and mood swings resolved.
- Sarah continued to be monitored by an endocrinologist to ensure long-term hormonal stability and to watch for any recurrence of Cushing’s disease.
This case study illustrates the clinical presentation, diagnosis, and treatment of a patient with Cushing’s syndrome, specifically due to a pituitary adenoma. Early diagnosis and appropriate intervention are crucial for improving the patient’s quality of life and preventing complications associated with excessive cortisol production.