Hyperpigmentaion in a 50-Year-Old Male
Journal Title: Journal of Enam Meical College - Year 2014, Vol 4, Issue 2
Abstract
A 50-year-old man with long standing diabetes mellitus presented with oliguria and preceding history of progressive anorexia, weakness and gradually worsening nausea and vomiting for 2 months. His blood pressure was 85/50 mm Hg. Hyperpigmentation of face (Fig 1), oral mucosa and hands (Fig 2) were noticed. Biochemical profile revealed raised creatinine (1.6 mg/dL [reference range 0.4--1.2 mg/dL]) and urea (60 mg/dL [reference range 15--45 mg/dL]), serum sodium 129 mmol/L (reference range 136--148 mmol/L), potassium 5.8 mmol/L (reference range 3.8--5.2 mmol/L) and chloride 95 mmol/L (reference range 95--107 mmol/L). Complete blood count revealed hemoglobin 13.8 gm/dL and white blood cell 10300/cu mm (neutrophils 54%, lymphocytes 33%, monocytes 3%, eosinophils 10%). Following fluid resuscitation and symptomatic treatment urine output improved and blood pressure raised up to 95/70 mm of Hg. Biochemical profile also became normal, except sodium level which was in lower limit of reference range and potassium in higher normal limit. Eosinophilia did not improve. Weakness and postural dizziness also remained same. Standing systolic blood pressure was 85 mm Hg which was 95 mm Hg in supine position and diastolic blood pressure in standing position dropped to 60 mm Hg which was 70 mm Hg in supine position. Intravenous dexamethasone was started. On the next day, morning blood for cortisol was sent which was 1.5 µg/dL (reference range 4.458--22.689 µg/dL). Short synacthen test was not done. Serum ACTH (adrenocorticotrophic hormone) was >1250 pg/mL (reference range 5.00--46.00 pg/mL). Primary adrenal insufficiency (Addison's disease) was diagnosed. Laboratory investigations to exclude other causes of adrenal insufficiency were unremarkable. Following glucocorticoid and minerolocorticoid replacement, patient improved clinically. Pigmentation of face (Fig 3) and hands (Fig 4) improved 6 months after starting treatment.
Authors and Affiliations
Mohiuddin Ahmed
Keywords
Related Articles
- EP ID EP36201
- DOI https://doi.org/10.3329/jemc.v4i2.19683
- Views 288
- Downloads 0
Comparison of ABO and Rh-D Blood Group Systems between the Garo Tribal People of Mymensingh and General People of Dhaka City
Background: The distribution pattern of ABO and Rh-D blood group in our country including the tribal people is not fully established as elaborated and large scale studies have not been carried out on it. Therefore this s...
Cat Scratch Disease
We report a case of cat scratch disease in a young boy who presented in the outpatient department of Enam Medical College Hospital, Savar, Dhaka with history of cat scratch and regional painful lymphadenopathy. The dia...
From the Desk of Editor-in-Chief 6(2)
Alhamdulillah! We are already in the 6th year of successful publication of Journal of Enam Medical College and the journal is indexed in more than a dozen indexing databases. We share this success with the contributors...
Clopidogrel Resistance: Current Issues
Antiplatelet agents are mainly used in the prevention and management of atherothrombotic complications. Dual antiplatelet therapy, combining aspirin and clopidogrel, is the standard care for patients having acute coron...
Serum Lipids and Diabetic Retinopathy in Newly Diagnosed Type 2 Diabetic Subjects
Background: Diabetic retinopathy is the commonest and usually the first observable vascular complication of diabetes mellitus. Along with hyperglycaemia, dyslipidaemia is a contributing factor for the occurrence of dia...