Sunday, May 28, 2023
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Professor of Medicine
Division of Endocrinology
Diabetes and Clinical Nutrition
Professor of Neurological Surgery
Director, OHSU Pituitary Center
Oregon Health & Science University
Portland, Oregon
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Professor of Medicine
Division of Endocrinology
Diabetes and Clinical Nutrition
Professor of Neurological Surgery
Director, OHSU Pituitary Center
Oregon Health & Science University
Portland, Oregon
Medscape, LLC staff have disclosed that they have no relevant financial relationships.
This activity has been peer reviewed and the reviewer has disclosed no relevant financial relationships.
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Tammy came to her appointment last week being distraught over a recent 40-pound weight gain. "My friends tell me not to worry about it," she explained during her initial visit. "The pandemic has caused most of them to gain weight, too, but not one of my friends has put on 40 pounds!" Unappeased by her friends' attempts to comfort her, she felt that something was amiss with her body. "I have stretch marks on my stomach from all the weight gain. It's awful! I'm growing hair places it shouldn't be growing, and I haven't had a period for 6 months," she confided.
On physical examination, Tammy's weight gain was centripetal with supraclavicular fat. Her stretch marks were purple and notably wide (> 1 cm). Tammy was sent for blood work and returns to the clinic today to discuss her results. Her current medical history and most recent lab results are shown in Table 1.
Table 1. Tammy's Medical Record
|
History |
Findings |
|---|---|
|
Medical |
T2D and hypertension for 1 year |
|
Current medications |
Metformin; lisinopril |
|
Social/occupational |
Project manager at a technology company; recently married |
|
Physical exam |
Findings |
|
General |
Coarse, dark hair on upper lip and chin; purple stretch marks on abdomen of > 1 cm; complains of muscle weakness; bruising |
|
Vital signs |
BP: 147/95 mm Hg Heart rate: 67 bpm |
|
BMI |
35 kg/m2 |
|
CBC |
Results |
|
|
Normal |
|
Metabolic panel |
Results |
|
HbA1c |
9% |
|
Lipid panel |
LDL: 100 mg/dL; HDL: 45 mg/dL; TG: 250 mg/dL |
|
FT4 |
0.8 ng/dL |
|
TSH |
0.88 ng/dL |
|
BUN, creatinine |
20 mg/dL, 0.8 mg/dL |
|
Serum glucose |
115 mg/dL |
|
AST/ALT |
31 U/L, 35 U/L |
|
Albumin |
4.4 mg/dL |
ALT = alanine aminotransferase; AST = aspartate aminotransferase; BMI = body mass index; BP = blood pressure; bpm = beats per minute; BUN = serum urea nitrogen; CBC = complete blood count; FT4 = free T4; HbA1c = glycated hemoglobin; HDL-C= high-density lipoprotein cholesterol; LDL-C = low-density lipoprotein cholesterol; T2D = type 2 diabetes; TG = triglycerides; TSH = thyroid-stimulating hormone.
Tammy has a 2-year history of T2D. Her T2D had been well controlled on metformin; however, last week's blood draw returned a glycated hemoglobin (HbA1c) level of 9%. "I eat more vegetables and salad now than ever before, but it doesn't seem to matter," she laments, "I'm overweight. I'm tired all the time." When asked if she is experiencing muscle weakness or fatigue, she responds, "I notice that I'm holding the railing when I go up or down the stairs, and I'm having some trouble walking. I feel like my legs may give out."
