Monday, January 14, 2008

Private Practice

A 30 year old woman presents to your clinic because she's lost her appetite recently. She feels really tired all the time; the fatigue gets better when she rests, but it's like she has no energy. She has general weakness and has had some weight loss. You assess for depression, but it seems to be more than that. She has nausea and occasional vomiting, abdominal pain, diarrhea, and constipation. She's felt dizzy on occasion. She says she enjoys laying out in the sun cause she tans really easily. On exam, you find orthostatic hypotension and notice this:

Challenge: What's the diagnosis?

Related Question:
1. What's seen on the image?

Image shown under fair use.


Alex said...

telangiectasia? HHT

not sure about this one

Craig said...

Private Practice

This is primary adrenal insufficiency, also known as Addison’s disease (and I have been told, Addison is a main character in the show Private Practice). The image shows patchy pigmentation on the inner surface of the lips and buccal mucosa along the line of dental occlusion. Hyperpigmentation (supported by the patient noticing that she’s tanning) is seen in nearly all patients with primary adrenal insufficiency.

Source: UpToDate (image was originally from Williams Textbook of Endocrinology).

Alex said...

oh, DOH!. i see now that it is "patchy." I kept thinking the fatigue was from anemia. Plus we talked about HHT the other day. I also considered Peutz-Jeghers syndrome, which has even more defined borders and anemia.