Concluded Case

Sudden onset obesity

A 25 years old male came in O.P.D with history of sudden increase in weight in last 3 months. No co -morbidities like hypertension, DM , hypothyroidism. He had abnormal fat deposition below chin , nape of neck and amd axillary regions. Send his investigations for lipid profile, s.cortisol , dexamethasone suppression test and 24 hour urinary cortisol Any further suggestions welcomed

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Concluded answer

Dr golam saying fine ,I second him Upper body half fat deposition 1.cushingoid 2.depression 3.sleep distrbence 4.drugs intake e.g. anti depressant,anti psychotics,anti hypertensive and thyroid treatment. Lower body half fat deposition Kidney and heart disease

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CUSHING’S SYNDROME most probable diagnosis as fat deposited at below the chin, nape of neck area. Other medical conditions must be ruled out are..... 1. Depression 2. Notifiable sleep disturbances 3. Drug history (for seizure, anti depressant, anti hypertensive, thyroid medicines, psychiatric medicines, corticosteroid etc) 4. Kidney and heart problems (but these usually increases fat lower body part and ankles)

Dr golam saying fine ,I second him Upper body half fat deposition 1.cushingoid 2.depression 3.sleep distrbence 4.drugs intake e.g. anti depressant,anti psychotics,anti hypertensive and thyroid treatment. Lower body half fat deposition Kidney and heart disease

Thank you sir for mentioning
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Area of fat distribution suggestive of Cushings.any h/o steroid intake?

Review with investigations and history of steroids Sir

First and for most change the life style. Essential physical activity or exercise. Blood test for full profile. Age 25ys? I am confused to see the part of your photos of the patient. Please it clear again.

ANY HISTORY OF.. DRUGS.. STEROIDS.. ANTIDEPRESSANTS.. ? OBESITY.. NEED'S.. HORMONAL STUDY..WITH.. ENDOCRINOLOGIST OPINION..

Ask for history of steroid intake...also some homeopathy medications. Review with investigations sent

Review after report, it may be due to Cushing syndrome... Required 24 hr urinary cortisol

Wait for Cortisol and Steroid suppression test results. Repeat TSH & Anti TPO .

Agree @Dr. Viraj R. Naik sir

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