Renal Case: 38-year-old Man with Purple Stretch Marks

00:01 Okay, let's turn to another clinical case.

00:03 We have a 38-year-old gentleman who has no significant past medical history and he presented to his physician's office for new-onset hypertension over the last 2 months.

00:12 He also complained of a more rounded face, weight gain, and an increase in abdominal girth.

00:19 He's really quite upset because he also noted some purple stretch marks in his abdomen and he's never had that before.

00:25 On physical exam, blood pressure is elevated at 170/95 mmHg, he has a rounded face, he has centripetal obesity, so obesity in his abdominal region, and he has purple striae over the abdomen.

00:37 His labs are remarkable for a glucose of 178 and you can see that a normal glucose should be less than 106 mg/dL.

00:46 He has a plasma renin activity and plasma aldosterone concentration that are quite low.

00:51 So, the question is, what is the next step in evaluating the cause of this gentleman's hypertension? Let's go back through our case and see if we've got some diagnostic clues.

01:01 So, number one, he's 38 so he's relatively young and has new-onset hypertension in somebody who has not had hypertension previously.

01:09 On physical exam, he has a rounded face, what we would call, perhaps, moon facies.

01:14 He also has noted an increase in abdominal girth and you noticed on physical exam he has centripetal obesity.

01:21 He has purple striae over the abdomen in the setting of an elevated blood glucose despite the fact that he's not diagnosed with diabetes mellitus.

01:30 Taken together, this is highly suspect for Cushing's disease or Cushing's syndrome.

01:35 So, what is the next step in evaluating the cause of this gentleman's hypertension? We would want to purse a 24-hour urine cortisol and a low dexamethasone suppression test.

01:47 And we'll go over why that's the answer in the next couple of slides.