16 yrd old frmale pt with no previous comorbs presented with C/O secondary amenorrhea , easy fatiguability and weight gain (13kg) for 1 year , hair fall, heat intolerance , sweating, imsomnia, on and off head ache e blirring of vision.
On examination pt has fine tremors, pruple striae on Rt side of abdomen , hirsutism but normal axillary and pubic hair distribution .Pt has used COCs for 8 months then primulut for 3 cycles then stopped 1 month ago currently she on tab Evion for last 1 month
Labs
Serum cortisol morning 18.7
Serum cortisol 17.7
DHEA 9.7
U/S abd pelvis normal
Pt is advised serum prolactin, FSH and LH
And MRI brain
Q what are the probable diagnoses?
Few points should be clarified before the diagnosis is made:
TSH 1.2
T3 1.1
T4 1.6
Bp 120/80
Ultrasound pelvis normal studies no evidence of PCOs
Rest of examination findings and investigatioms are not avaible
Cushing's disease should be investigated in this patient as a possible cause if weight gain, headache, amenorrhea, hirsuitism, and purplish abdominal striae.
The following investigations may be advised: