PS2.002Weight Gain: guilty or not?

Author(s): 
Sara Almeida, M Carvalho
(1) USF Famílias, ACES Entre Douro e Vouga I, Santa Maria Feira, Portugal
(2) USF Famílias, ACES Entre Douro e Vouga I, Santa Maria Feira, Portugal
Corresponding author: Dr Sara Almeida, ACES Entre Douro E Vouga I, USF Famílias, Santa Maria Feira, Portugal.
E-mail: saragpalmeida@gmail.com
Text: 
Background: Although the vast majority of weight gain can be attributed to behavioural features that affect diet and physical activity patterns, the history may suggest secondary causes that merit further evaluation. One of them, endogenous Cushing’s syndrome, is a rare condition - prevalence is only 13 cases per 1 million people.
Case Report: 36-years-old Caucasian married female. Without past medical history or chronic medication.
She reported weight gain, about 8kg over the last two years, even with healthy diet and physical activity. Her physical examination revealed a body mass index of 25.9 (higher than that recorded 2 years ago: 23.4), rounded face and slight hirsutism. Laboratory investigation, with measurement of cortisol, documented endogenous hypercortisolism. Then, was requested renal and adrenal ultrasound, that showed: "... hypoechogenicity in the left adrenal gland...". Renal computed tomography revealed: " a nodule in the left adrenal gland, with 2.5cm...".
The patient was evaluated by Endocrinology, at the local hospital, which confirmed the diagnosis of Cushing's Syndrome, due to Adrenal Adenoma, and underwent unilateral adrenalectomy.
Conclusions: Diagnosis of Cushing Syndrome can be very challenging, because patients can present with a wide spectrum of symptoms. Some of them are non-specific findings and features seen commonly in the general population (like weight gain). So, a careful history and physical examination will be essential. And, this condition should be suspected, in some patients.
In such cases, Family Doctor play an important role and could be aware, even with subtle manifestations.