1) Inspired by @AaronGoodman33
Middle aged male gets tired easily, had a hx of TLOC on sudden standing up, low grade fever × past 1 year
Clinical exam --> gradual darkening of skin and oral mucosa.
What is your diagnosis?
#MedTwitter
Middle aged male gets tired easily, had a hx of TLOC on sudden standing up, low grade fever × past 1 year
Clinical exam --> gradual darkening of skin and oral mucosa.
What is your diagnosis?
#MedTwitter
What are your differentials?
What labs +/- imaging would you request?
What labs +/- imaging would you request?
I am surprised nobody thought of hemochromatosis.
Unexplained fatigue and postural hypotension --> hemochromatic cardiomyopathy
Low grade fever --> hemochromatosis renders you susceptible to infection
Hyperpigmentation --> hemoCHROMATOSIS
Unexplained fatigue and postural hypotension --> hemochromatic cardiomyopathy
Low grade fever --> hemochromatosis renders you susceptible to infection
Hyperpigmentation --> hemoCHROMATOSIS
Seems like a gestalt diagnosis for most!
CBC --> eosinophilia
Electrolytes --> Na+ 133 and K+ 4.4
This does look like Addison ds.
CBC --> eosinophilia
Electrolytes --> Na+ 133 and K+ 4.4
This does look like Addison ds.
8 am serum cortisol --> 2.76 (precluding an ACTH stimulation test)
Sr ACTH > 1250
Its Addison ds.
CT adrenals --> nothing significant.
Its probably autoimmune --> endocrine opinion!
Sr ACTH > 1250
Its Addison ds.
CT adrenals --> nothing significant.
Its probably autoimmune --> endocrine opinion!
Endocrine people here are telling me that adrenal histoplasmosis has replaced TB here in Eastern India!
Any more clinical pearls for us learners?
#MedTwitter
#Endotwitter
Any more clinical pearls for us learners?
#MedTwitter
#Endotwitter
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