Q:

How is the patient in Case 3 managed?

waelhammad
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2022-11-18
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A 47-year-old lady with complaints of decreased ability to sleep has been admitted under the department of psychiatry and found to have depression with generalized anxiety disorder. She has also been diagnosed with diabetes and hypertension for 4 years for which she is on metformin 2 g/day with glimepiride 4 mg/day and amlodipine 10 mg/day. She has oligoamenorrhea for many years and has cycles only after taking medroxyprogesterone acetate for 5 days. On examination, her BMI is 31 kg/m2, has waist circumference of 102 cm, acanthosis nigricans, no striae or bruising. Blood pressure of 140/90 mm Hg. Her psychiatry consultant wants to rule out Cushing’s syndrome as a cause of the depression and metabolic features. What would you do next?

How is the patient in Case 3 managed?

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waelhammad
2022-11-18
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As the pretest probability of Cushing’s syndrome is low and that of pseudo- Cushing’s high, she is subjected to midnight serum cortisol which is 1.4 mg/dL and her LDDST is 0.6 mg/dL. Hence, Cushing’s syndrome is ruled out and she is followed up.

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