Case Presentation Cushing.02.04.1399

History

21. A 28-year-old man from Neyshabour; he is a farmer.
21. He presents with 12 – month history of abdominal obesity, round face, acne, mood swing, decreased libido, broad and purple striae and progressive proximal muscle weakness.
21. Furthermore, after falling off a ladder, he has not been able to walk anymore and has been suffering from an excruciating low back pain since 9 months ago.
21. He has history of genital wart since 7 months ago.
21. Based on above-mentioned symptoms, work-ups for Cushing syndrome were started.
21. PMH: Genital warts
21. DH: Ketoconazole / losartan / Amp testosterone / Vitamin D / Ca, Ganoderma lucidum
21. Family HX: not remarkable
21.  SH: recreational drugs, Naswar, opium, tramadole, smoking
21. PE: BP: 190/110 mmHg, PR: 80, RR: 16, W: 54 kg, H: 158 cm BMI: 21.6Kg/m2
21. He was bed ridden but alert with moon face, facial plethora, thin and brittle skin, and a non-tender distended abdomen with broad purplish striae.
21. Neurologic examination: proximal myopathy
21. No clubbing or edema in extremities