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A 17 YEAR OLD MALE WITH IATROGENIC CUSHING'S SYNDROME
A 17 Year old male came to the OPD with
Chief complaints
• Puffiness of face
• Striations all over the body
• Blurring of vision
• Ulcers
History of present illness
• Patient was asymptomatic 2 years ago
and then he suddenly developed rashes all over the body ( Ring worm ) for which he was taken to the ayurvedic clinic and was prescribed some medications ( unknown medication ) and he is on medication for 1 year .
• He also mentioned he went to a private local hospital because his rash did not subside. where he was prescribed with steroids and on these medications for 1 year .
• 6 months before he visited kamineni for the first time because his symptoms didn't subside and on irregular medication . He was prescribed some topical applications and medications .
Past History
Not a k/c/o DM , HTN , Epilepsy , TB , Bronchial asthma , CAD , CVA , Thyroid disorders .
Personal History
Diet - Mixed
Appetite - More than Normal
Sleep - Decreased
Bladder & Bowel movements - Regular
No addictions
Family History
No H/o DM , HTN , CVA , CAD , Bronchial asthma , Thyroid disorders , epilepsy in the family .
General Examination
Patient is conscious, coherent and cooperative
Moderately built and moderately nourished
No Pallor
No Icterus
No cyanosis
No Clubbing
No koilonychia
No Lymphadenopathy
Slight pedal oedema
VITALS
Temperature - 104°F
Pulse rate - 96 bpm
Respiratory Rate - 16 cpm
BP - 140/80 mmHg
SPO2 at room air - 98%
GRBS - 114 mg/dl
SYSTEMIC EXAMINATION
Cardiovascular system
INSPECTION
Chest wall is bilaterally symmetrical .
No precordial bulge .
No visible pulsations, engorged veins, scars, sinuses .
PALPATION
JVP - Normal
APEX BEAT - Felt in the left 5 th intercostal space in the midclavicular line .
AUSCULTATION
S1 S2 heard .
No murmurs
Respiratory system
Position of the trachea - Centre
Bilateral air entry +
Normal vesicular breath sounds heard
No added sounds .
Per abdomen
Abdomen is soft , non tender
No organomegaly
Bowel sounds heard
No palpable mass
No free fluid .
Central nervous system
Patient is Conscious
Speech: normal
No signs of Meningeal irritation
Motor & sensory system: normal
Reflexes: normal
Cranial nerves: intact .
Provisional diagnosis
IATROGENIC CUSHING'S SYNDROME
Treatment
SALT RESTRICTED DIET
DIABETIC DIET
T. TELMA - AM (40/5) mg PO /OD
T .METFORMIN 500mg / PO/OD
T. ITRACONAZOLE 100mg / PO /BD
LULIFIN CREAM FOR L/A
TAB . LEVOCITREZIN 10mg
TAB . NICARDIA 10mg SOS
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