Adrenal crisis , secondary adrenal insufficiency and iatrogenic cushing syndrome

 Gen med case presentation;

Jan 22/01/22

Name;Ramya reddy pebbeti.

 Roll no;105 .

This is online E log book to discuss our patient’s de-identified health data shared after taking his/her/guardian’s signed informed consent. Here we discuss our individual patient’s problems through series of inputs from available global online community of experts with an aim to solve those patients’ clinical problems with collective current best evidence-based inputs. This e-log book also reflects my patient centred online learning portfolio and your valuable inputs on comment box is welcome. 

 I’ve been given this case to solve in an attempt to understand the topic of “patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations, and come up with diagnosis and treatment plan

Following is the view of my case :

CASE PRESENTATION ;

DOA:20/01/22

CC -17 year old male came to casuality with c/o Giddiness since 1week, SOB on exertion since 2days with nausea and vomiting

HOPI- patient was apparently asymptomatic 1week ago then he doveloped giddiness which was sudden in onset no aggravating factors relieved on consumption of food. Later he doveloped SOB 2 days ago with no aggravating and reliving factors along with nausea and vomiting with consumption of food as aggravating factor.

PAST HISTORY- K/C/O cushings syndrome

PERSONAL HISTORY-

occupation -student

Mixed diet

appetite -normal 

bowel and bladder - Normal

no addiction 

FAMILY HISTORY - not significant 

PHYSICAL EXAMINATION-

no pallor, icterus, cyanosis, clubbing,  dehydration 

VITALS-

temperature - afebrile 

pulse rate - 80 bpm 

RR - 12 cpm 

BP - 80/50 mm hg 

SPO2 - 98 on RA 

GRBS - 117.mg %

SYSTEMIC EXAMINATION-

CVS-S1 ,S2 heard ,no murmurs 

RS -BAE +

 P/A - soft ,non tender 

CNS -

speech - normal 

 power 

U.L - 5/5 

L.L - 3/5 at presentation in opd ,now 4/5 

TONE - normal 

REFLEXES 

KNEE - + 

BICEP - + 

TRICEP-+

ANKLE - + 

BRACHIORADIALIS - + 

PLANTAR - withdrawal

Images of the patient; (recent)

Old image of the pt;

PROVISIONAL DIAGNOSIS-

Adrenal crisis (Distributive shock secondary to adrenal insufficiancy)

Investigations;

RBS;

CUE;

CBP;

LFT;

Seruma creatinine;

Serum electrolytes;

ABG;

BLODD UREA;

TREATMENT -

1)Inj norad 2amp in 46ml NS infusion @ 0.02mcg/kg/min if BPis low 

2)Inj hydrocortisone 100mg/iv/od

3)Inj pantop 40mg/iv/od

4)Inj zofer 4mg/iv/tid

5)IVF NS,RL,DNS-100ml/hr

6)BP charting

PR/Spo2/Temp charting

GRBS 8th hrly