1) What is some further information that could be requested based on the scenari
ID: 3509686 • Letter: 1
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1) What is some further information that could be requested based on the scenario that would need to be known before the final diagnosis?This patient was referred to the outpatient endocrinology clinic with complaints of excessive weight gain and muscle weakness. He reported to have gained 8 kgs in 12 months. Physical examination revealed a moon face appearance, truncal obesity, a buffalo hump, hirsutism, and purple striae in the axilla, periumbilical, and inguinal regions. Numerous erythematous, scaly psoriatic plaques were located on the shoulders, extremities, hands, and feet. Vital signs revealed an arterial blood pressure of 130/80 mmHg, pulse rate 75/min, height 172 cm, weight 85 kg, and body mass index 28.7 kg/cm2. On laboratory studies, liver and kidney function tests and fasting blood glucose were within normal limits. The following were found: morning adrenocorticotropic hormone (ACTH): 17 : 53 pg/ml (N: 7.2–63.3); morning basal cortisol: 3.83 mg/dL (–18.0). Other anterior hypophyseal hormones were as follows: thyroid stimulating hormone (TSH): 2.77 /ml (N: 0.27–4.2); fT4: 17.6 pmol/L (N: 12–22); fT3: 7.26 pmol/L (N: 3.1–6.8); prolactin: 7.34 ng/ml (N: 4.04–15.2); follicle stimulated hormone (FSH): 3.81 mIU/mL; luteinizing hormone (LH): 2.7 mIU/mL; total testosterone: 2.77 ng/mL (N: 2.9–8.36). 1 g ACTH stimulation test was performed to evaluate hypophyseal-adrenal axis and there was insufficient response to the test (peak cortisol level 7.7 mg/dL). Patient History: 12 years ago, he was diagnosed with psoriasis vulgaris. To treat this condition, he used clobetasol propionate 00.5% ointment continuously at 150 mg/week for the past 12 years, but stopped treatment independently one month prior to referral. Family History: No history of any chronic or acute conditions, very healthy parents.
1) What is some further information that could be requested based on the scenario that would need to be known before the final diagnosis?
This patient was referred to the outpatient endocrinology clinic with complaints of excessive weight gain and muscle weakness. He reported to have gained 8 kgs in 12 months. Physical examination revealed a moon face appearance, truncal obesity, a buffalo hump, hirsutism, and purple striae in the axilla, periumbilical, and inguinal regions. Numerous erythematous, scaly psoriatic plaques were located on the shoulders, extremities, hands, and feet. Vital signs revealed an arterial blood pressure of 130/80 mmHg, pulse rate 75/min, height 172 cm, weight 85 kg, and body mass index 28.7 kg/cm2. On laboratory studies, liver and kidney function tests and fasting blood glucose were within normal limits. The following were found: morning adrenocorticotropic hormone (ACTH): 17 : 53 pg/ml (N: 7.2–63.3); morning basal cortisol: 3.83 mg/dL (–18.0). Other anterior hypophyseal hormones were as follows: thyroid stimulating hormone (TSH): 2.77 /ml (N: 0.27–4.2); fT4: 17.6 pmol/L (N: 12–22); fT3: 7.26 pmol/L (N: 3.1–6.8); prolactin: 7.34 ng/ml (N: 4.04–15.2); follicle stimulated hormone (FSH): 3.81 mIU/mL; luteinizing hormone (LH): 2.7 mIU/mL; total testosterone: 2.77 ng/mL (N: 2.9–8.36). 1 g ACTH stimulation test was performed to evaluate hypophyseal-adrenal axis and there was insufficient response to the test (peak cortisol level 7.7 mg/dL). Patient History: 12 years ago, he was diagnosed with psoriasis vulgaris. To treat this condition, he used clobetasol propionate 00.5% ointment continuously at 150 mg/week for the past 12 years, but stopped treatment independently one month prior to referral. Family History: No history of any chronic or acute conditions, very healthy parents.
1) What is some further information that could be requested based on the scenario that would need to be known before the final diagnosis?
This patient was referred to the outpatient endocrinology clinic with complaints of excessive weight gain and muscle weakness. He reported to have gained 8 kgs in 12 months. Physical examination revealed a moon face appearance, truncal obesity, a buffalo hump, hirsutism, and purple striae in the axilla, periumbilical, and inguinal regions. Numerous erythematous, scaly psoriatic plaques were located on the shoulders, extremities, hands, and feet. Vital signs revealed an arterial blood pressure of 130/80 mmHg, pulse rate 75/min, height 172 cm, weight 85 kg, and body mass index 28.7 kg/cm2. On laboratory studies, liver and kidney function tests and fasting blood glucose were within normal limits. The following were found: morning adrenocorticotropic hormone (ACTH): 17 : 53 pg/ml (N: 7.2–63.3); morning basal cortisol: 3.83 mg/dL (–18.0). Other anterior hypophyseal hormones were as follows: thyroid stimulating hormone (TSH): 2.77 /ml (N: 0.27–4.2); fT4: 17.6 pmol/L (N: 12–22); fT3: 7.26 pmol/L (N: 3.1–6.8); prolactin: 7.34 ng/ml (N: 4.04–15.2); follicle stimulated hormone (FSH): 3.81 mIU/mL; luteinizing hormone (LH): 2.7 mIU/mL; total testosterone: 2.77 ng/mL (N: 2.9–8.36). 1 g ACTH stimulation test was performed to evaluate hypophyseal-adrenal axis and there was insufficient response to the test (peak cortisol level 7.7 mg/dL). Patient History: 12 years ago, he was diagnosed with psoriasis vulgaris. To treat this condition, he used clobetasol propionate 00.5% ointment continuously at 150 mg/week for the past 12 years, but stopped treatment independently one month prior to referral. Family History: No history of any chronic or acute conditions, very healthy parents.
Explanation / Answer
The differential diagnosis of psoriasis includes dermatological conditions similar in appearance such as discoid eczema, seborrhoeic eczema, pityriasis rosea (may be confused with guttate psoriasis), nail fungus(may be confused with nail psoriasis) or cutaneous T cell lymphoma (50% of individuals with this cancer are initially misdiagnosed with psoriasis).Dermatologic manifestations of systemic illnesses such as the rash of secondary syphilis may also be confused with psoriasis.
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