What is your primary diagnosis, and why? What is the pathophysiology of the diagnosis?
A 54-year-old female presented with proximal muscle weakness, easy bruising, weight gain, and
worsening of hypertension. She had also noticed increasing facial hair for six months and fat
deposition in the back of her neck. A recent laboratory test had shown high fasting blood
glucose. She had history of hypertension, hyperlipidemia, and osteoporosis for the past five
years. She was on a bisphosphonate therapy. There was a family history of hypertension,
diabetes mellitus type 2, and coronary artery disease. She never smoked and did not drink
alcohol.
On examination her blood pressure was 140/90 mm/Hg. She was obese but she felt that her face
was fuller than before. Examination revealed dorsocervical fat pad, ecchymosis on skin, and a
few coarse plucked hairs on her chin. She had thin legs with mild edema and was unable to stand
without taking support of the chair.
1. What is your primary diagnosis, and why?
2. What is the pathophysiology of the diagnosis?
3. One differential diagnosis for the case.
Answer preview What is your primary diagnosis, and why? What is the pathophysiology of the diagnosis?
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