Can someone answer this q?

[mountaindew2006]

thanks Idio for answering the previous q.

Just wondering though.

This woman who's 23 yo comes in and shes had intermittent ammnorrhea since the birth of her first child five years ago. At the time of her delievery she was given 10 units of blood. She feels tired and depressed. Her skin is THICK AND doughy. Which of the following is most likely?
a)adrenocortical insuff
b)chronic fatigue syndrome
c)hemochromatosis
d)HIV
e)Pit Necrosis

I was thinking maybe sheehans thus pituitary necrosis. But then i dont know how that woudl explain the thick and doughy skin. I was thinking adrenocortical insuff but thats DARK skin. So my leading cause would be E from Sheehans.

What do you guys think?

thanks again

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[DarksideAllstar]

Pulling this out of my ass...
Maybe she has secondary hypothyroidism due to pit necrosis (ie no TSH produced/released bc of Sheehans). I dont recall learning that the skin becomes thick and doughy with hypothyroidism though. I know that your soft tissues can enlarge with GH increase, but I dont see any reason why we would consider this in the scenario given.

 

[Scooby Moo]

Maybe they mean myxedema when they describe "thick and doughy skin?" I'd choose E too.

 

[Jaded Soul]

I agree that it is Sheehan's syndrome. Don't read too much into the skin findings. The key is the in the history of blood loss during delivery and subsequent irregular periods. That's classic for postpartum pituatary necrosis.

LH/FSH deficiency explains her intermittent amenorrhea. TSH deficiency explains her mood disturbance, tiredness, and those skin findings. ACTH deficiency will contribute to tiredness as well.

Also, adrenocortical insufficiency doesn't necessarily give you dark skin if it's a central cause (i.e. secondary to Sheehan's). Hyperpigmentation occurs with primary adrenocortical insufficiency. In response to lack of cortisol, CRH increases and POMC increases, which splits into ACTH, MSH, and other things I can't remember. The MSH causes hyperpigmentation.

 

[Idiopathic]

Pretty obvious Sheehan's.

 

[bigfrank]

e

The doughy skin can be used to describe myxedema (per PACtoDOC) or it could also be used to describe dehydration, which can accompany Sheehan's Syndrome.

By the way, I have heard people mentioning that the patient could have darkened skin. This is an incorrect assumption: recall that hyperpigmentation accompanies Primary adrenal insufficiency, not secondary (in which ACTH would be LOW).

This is an example of a key pathophysiological association that can be confused during the Step I.

 

[PACtoDOC]

concur with BF. She has a stalk syndrome likely and the doughy skin is myxedema. The only thing missing is "fine lines and wrinkles" right?

 

[EctopicFetus]

Dont get caught up too much.. Most Qs are str8 fwd on the boards from my experience and that being said it is obviously E.

 

[Jaded Soul]

By the way, I have heard people mentioning that the patient could have darkened skin. This is an incorrect assumption: recall that hyperpigmentation accompanies Primary adrenal insufficiency, not secondary (in which ACTH would be LOW).

This is an example of a key pathophysiological association that can be confused during the Step I.

In other words, the same thing I wrote earlier.

 

[bigfrank]

I guess you did. Sorry about that. Your fluid writing must have penetrated subliminally into me.

 

[Jalby]

Another vote for E. Same reasons as Jaded and BF

 

[bigfrank]

Your fluid writing must have penetrated subliminally into me.

Jaded, sorry to have (accidentally) written such a hyper-sexual post.