Plueral effusion

44 yr old lady ,not a k/c/o DM/HT/Dyslipidemia c/o dyspnoea on exertion for the past 3 yrs along with 10% weight gain. On examination bilateral pitting pedal edema present more so on the right leg (photo attached) vitals are stable and all the systemic examinations normal. Also attaching the photo of her dry,coarse skin,mostly due to hypothyroidism P.s:Can pedal edema be severe enough to cause medial deviation of the toes??(photo attached) If not what are the reasons for it??

This is a 17 year old male presenting with such lesions over face as shown, I am suspecting to be a case of Acne Vulgaris *Management* How do u treat your acne patients? What do u follow to treat such patients? Any guru mantra if, kindly share 🙏 Meanwhile, I have started him on following - Isotane 20 OD, Wysolone 10 BD, Doxycycline 100mg OD for 10 days, Oint Retino A 0.025% at bedtime after washing face,

B/l pedal oedema, shortness of breath, since 3-4 months ,no past history..

Hi doctors ,one 55yrs old female patient with complaints of severe right leg pain since one month.doppler study shows atherosclerotic lesion in ATA PTA.... plz @advice me Treatment and management

CUSHING'S SYNDROME. Cushing's syndrome is a hormonal disorder caused by prolonged exposure of the body's tissues to the high levels of hormone cortisol.It is also known as HYPERCORTISOLISM.It commonly affects adults aged 20-50. Too much cortisol in the body,regardless of the cause is called CUSHING'S SYNDROME. Pituitary gland tumour which produces excess ACTH leading to hypercortisolism is called CUSHING'S DISEASE. Hypercortisolism due to excess ACTH produced by a tumour elsewhere in the body is called ECTOPIC CUSHING'S SYNDROME. Cushing's syndrome caused by taking excess steroid medications is called EXOGENOUS CUSHING'S SYNDROME. SIGNS AND SYMPTOMS. Patients with Cushing's syndrome have upper body obesity and slender arms and legs. Most people with Cushing's syndrome have Round ,red, full face like a moon. moon facies Truncal obesity,supraclavicular fat pads,buffalo hump,weight gain. SKIN CHANGES. Atrophy, Purple striae. Easy bruising. Hirsutism. Acne, Pigmentation MUSCLE AND BONE CHANGES. Proximal muscle wasting and weakness Bone pain or tenderness. Rib and spine fractures caused by thinning of bones. Osteopenia or osteoporosis. PSYCHOLOGICAL PROBLEMS. Depression Cognitive function. Emotional lability. Diabetes or impaired glucose tolerance. Thirst,polydipsia,polyuria. Hypertension. Nephrolithiasis. Gonadal dysfunction,reduced libido,erection problems. Irregular periods. Growth restriction in a child. Destruction of anterior pituitary may cause hypothyroidism and amenorrhoea. Patients with ACTH producing tumours may develop headache,visual problems and galactorrhea. WHAT CAUSES CUSHING'S SYNDROME. Tasks of cortisol. *Helps maintain blood pressure and cardiovascular function. *Reduces the immune system's inflammatory response. *Balancing the effects of insulin *Regulates the metabolism of carbohydrates,proteins and fats. 1) Most common cause of cushing's syndrome is exogenous intake of steroids.like Prednisone for asthma,rheumatoid arthritis,lupus.Glucocorticoids taken to suppress immune system after transplantation to keep the body from rejecting the new tissue or organ. 2)Next common cause is PITUITARY ADENOMAS. 3) ECTOPIC ACTH SYNDROME. Benign or malignant tumours that arise outside the pituitary can produce ACTH.They are lung tumours especially all cell lung cancer,carcinoid tumours,thymomas,pancreatic islet cell tumours and medullary carcinomas of the Thyroid. 4) ADRENAL TUMOURS. Adrenal adenomas or adrenocortical cancers can cause Cushing's syndrome. DIAGNOSIS. The three most common tests used to diagnose Cushing's syndrome are. 1)24 HOUR URINARY FREE CORTISOL LEVELS. >>>50 - 100 if /day suggests Cushing's syndrome. 2) MEASURE MID NIGHT PLASMA CORTISOL AND LATE NIGHT SALIVARY CORTISOL. Cortisol production is normally suppressed at night ,but in Cushing's syndrome,this suppression doesn't occur . Cortisol levels of >>50 nmol/L , Cushing's syndrome is suspected. 3)LOW DOSE DEXAMETHASONE SUPPRESSION TEST.. (LDDST ).Here patient is given a low dose of dexamethasone ,by mouth every 6 hours for 2 days.Steroids signal the pituitary to release less of ACTH.So the normal response after taking dexamethasone is a drop in blood and urine cortisol levels.If cortisol levels do not drop,cushings syndrome is suspected. TESTS TO FIND THE CAUSE OF CUSHING'S SYNDROME. Once Cushing's syndrome is diagnosed,certain tests are done to locate the exact abnormality that leads to excess cortisol production. 1)CRH STIMULATION TEST. Injection of CRH causes a rise in ACTH and cortisol levels in patients with pituitary adenomas.But this response is not seen in adrenal tumours or ectopic ACTH producing tumours. 2)HIGH DOSE DEXAMETHASONE SUPPRESSION TEST (HDDST.) High doses of dexamethasone suppresses cortisol levels in people with pituitary adenomas but not ectopic ACTH producing tumours. 3)CT AND MRI. TREATMENT. Treatment depends on the exact cause of excess cortisol. PITUITARY ADENOMAS. Trans sphenoidal adenomectomy is most widely used surgery. For patients not suitable for surgery,radiation to the pituitary gland is given over a 6 week period. Cortisol inhibiting drugs like ketoconazole,mitotane,aminoglutethimide and methadone are also used. ECTOPIC ACTH SYNDROME Ectopic ACTH producing tumours or cancerous tissue is treated by surgery //radiation //chemotherapy //immunotherapy. ADRENAL GLAND TUMOURS. Surgery is the mainstay of treatment for benign and cancerous tumours off the adrenal glands. Primary pigmented micronodular adrenal disease and inherited Carney complex -primary tumours of the heart which cause Cushing's syndrome are treated by surgical removal of adrenal glands. POINTS TO REMEMBER. CUSHING'S SYNDROME IS A DISORDER CAUSED BY PROLONGED EXPOSURE OF THE BODY'S TISSUES TO HIGH LEVELS OF THE HORMONE CORTISOL. TYPICAL SYMPTOMS ARE UPPER BODY OBESITY,ROUND FACE,SKIN THAT BRUISES EASILY AND HEALS POORLY,WEAKENED BONES,ACNE AND MENSTRUAL IRREGULARITIES IN FEMALE,DECREASED FERTILITY IN MEN. IIATROGENIC CUSHING'S SYNDROME IS CAUSED BY EXPOSURE TO GLUCOCORTICOIDS. HYPERCORTISOLISM IS ALSO CAUSED BY PITUITARY TUMOURS OR LUNG TUMOURS. SEVERAL TESTS ARE DONE TO DIAGNOSE CUSHING'S SYNDROME AND IDENTIFY THE CAUSATIVE PATHOLOGY. TREATMENT DEPENDS ON THE CAUSE.THEY ARE SURGERY,RADIATION,CHEMOTHERAPY OR CORTISOL INHIBITING DRUGS.