A 50Y F came to the opd with C/o. of generalized swelling, unable to walk

                     General medicine 

                                         ~Case Discussion 

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A 50 year old female resident of Nalgonda came to the opd of General Medicine with:

   C/o. : Generalized swelling of stomach, face and upper and lower limbs. 

 History of Presenting illness: Apparently the patient was asymptomatic 4 years ago later she developed generalized weakness and pain. 1 year later ( 3 years ago) she had an episode of paralysis like attack after which she has stopped her usual daily work routine and had decreased physical activity. 1 year later (2 years ago) she developed back pain which is insidious in onset and gradual in progression in the lower back region of dragging type and aggravated on walking or any other movements and relieved on resting, 1 year later ( 1 year ago) she developed knee pain which is insidious in onset and gradual in progression, dragging type. Aggravated on walking and relieved on resting. Due to these pains she is currently on bed rest. 

         She is a chronic alcoholic and abuser of NSAIDS (paracetamol and diclofenac combination) .

         4 days ago she developed puffiness of face, buffalo hump over the nape, bloating of stomach , swelling of arms, legs and thighs.

 Past history: Nothing of similar complaints, had paralysis like attack 4 years ago.

Past history: No history of similar complaints in the past. Had an episode of paralysis like attack 3 years ago.

 Personal History: k/c/o Diabetes, uses Tab. METFORMIN 500mg.

          Decreased appetite since 1year

                 Adequate sleep

     Regular bowel bladder movements               Chronic alcoholic since 4 years drinks palm wine mixed with alcohol and sugar.

 General Examination - 

No pallor, icterus, cyanosis,lymphadenopathy 

Has generalized swelling, buffalo hump, moon face, pedal edema.

Vitals : 

Pulse rate - 72 bpm

Respiratory rate - 16 cpm

Temperature - Afebrile 

Blood pressure - 110 / 80 mm of Hg

Diagnosis: Idiopathic cushings Syndrome 

 Rx

Steroids