GENERAL MEDICINE CASE

SHIVANI KOMMERA 



A 17 YEAR OLD MALE WITH IATROGENIC CUSHING'S SYNDROME 

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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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