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+ (98) 9128093509
DDxPro
Possible Diagnoses
Adrenocortical carcinoma
Adrenocortical carcinoma
Progressive central obesity
Progressive obesity
Supraclavicular fat pads
Weight gain
Facial plethora
Skin atrophy
Hypertension
Insomnia
Nocturnal hyperarousal
Metabolic alkalosis
Wide purplish striae
Wide purplish striae on abdomen
Wide purplish striae on lower flanks
Low back pain
Proximal muscle weakness
Proximal myopathy
Thinning of the skin on the top of the hands
Weakness
Buffalo hump
Progressive face obesity
Cushing syndrome
Cushing syndrome
Irritability
Abdomen obesity
Anxiety
Central obesity
Face obesity
Neck obesity
Progressive obesity
Skin atrophy
Truncal obesity
Weight gain
Hypercortisolism
Hypertension
Round face
Amenorrhea
Decreased libido
Excess menses
Glucose intolerance
Menstrual changes
Oligomenorrhea
Variable menses
Ovarian hyperstimulation syndrome
Ovarian hyperstimulation syndrome
Abdominal discomfort
Abdominal distension
Bilateral ovarian enlargement
Corpus luteum cysts
Mild nausea
Multiple follicular
After using human chorionic gonadotropin
Anuria
Bloating
Dyspnea
Enlarged ovaries
Hypovolemia
Increased intraabdominal pressure
Increased vascular permeability
Intractable nausea
Low blood venous pressure
Low central venous pressure
Oliguria
Reduced liver perfusion
Severe abdominal pain
Hypothyroidism
Central hypothyroidism
Head irradiation
Men type 1
Neck irradiation
Traumatic brain injury
Hypogonadism
Pituitary hormone abnormalities
Cold intolerance
Fatigue
Weight gain
Muscle cramps
Weakness
Headache
Acromegaly
Adrenal insufficiency
Anorexia
Craniopharyngioma
Cretinism
Delayed sexual maturation
Dwarfism
Growth retardation
Hypothyroidism
Decreased short-term memory
Poor concentration
Hair loss
Brittle hair
Dry hair
Periorbital edema
Weakness
Constipation
Fatigue
Bradycardia
Dry skin
Nonpitting peripheral edema
Weight gain
Numbness in hand
Pain in hand
Sensory loss in first three fingers and half of fourth finger
Sensory loss of fingers
Tingling in hand
Puffy facies
Cognitive dysfunction
End stage renal disease
End stage renal disease
Anorexia
Dysgeusia
Fatigue
Nausea
Platelet dysfunction
Sexual dysfunction
Vomiting
Malnutrition
Amenorrhea
Central nervous system abnormalities
Decreased libido
Erectile dysfunction
Lethargy
Loss of concentration
Neuropathy
Pericarditis
Peripheral neuropathy
Seizures
Thyroid dysfunction
Menopause
Menopause
Headaches worsen during menopausal transition
Menstrual migraines worsen during menopausal transition
Cirrhosis
Biliary cirrhosis
Anesthesia
Increased need for sleep
Lack of stamina
Lethargy
Listlessness
Poor energy
Symptoms of temporal lobe seizures
Muscle weakness
Proximal muscle weakness
Absence of parenchymal kidney disease
Absence of shock
Amnesia
Anxiety
Ataxic gait
Babinski sign
Bizarre behavior
Clonus
Disorientation for time
Dyspraxia
Euphoria
Primary biliary cirrhosis
Malignancy
Portal hypertension
Urinary tract infection
Anesthesia
Burning sensation in extremities
Crawling sensation in extremities
Creeping sensation in extremities
Increased need for sleep
Lack of stamina
Lethargy
Listlessness
Numbness sensation in extremities
Paresthesia in entire hand
Paresthesia in wrist
Poor energy
Significant fatigue
Somatosensory symptoms
Symptoms of temporal lobe seizures
Tingling sensation in extremities
Concentration impairment
Cholangitis
Primary sclerosing cholangitis
Associated with inflammatory bowel diseases
Anesthesia
Increased need for sleep
Lack of stamina
Lethargy
Listlessness
Poor energy
Symptoms of temporal lobe seizures
Muscle weakness
Proximal muscle weakness
Increasing cholestasis
Right upper quadrant pain
Jaundice
Fatigue
Fever
Complication ulcerative colitis
Absence of parenchymal kidney disease
Absence of shock
Amnesia
Anxiety
Chronic atrial fibrillation
Chronic atrial fibrillation
Irregular pulse
Alcohol abuse
Arrhythmias
Atrial flutter
Atrial tachycardia
Atrioventricular nodal reentrant tachycardia
Atrioventricular reentrant tachycardia
Congestive heart failure
Diabetes mellitus
Higher midlife body mass index
Hypertension
Mitral regurgitation
Mitral stenosis
Rheumatic heart disease
Weight gain
Cardiomyopathy
Coronary artery disease
Palpitations
Pericarditis
Tachycardia
Adrenal suppression
Adrenal suppression
Hyperthyroidism
Anorexia
Arthralgia
Bruising
Centripetal obesity
Dizziness
Dorsocervical fat pad
Facial plethora
Fatigue
Glucocorticoid treatment
Glucocorticoid use
High corticosteroid doses
Increased appetite
Moon face
Myalgia
Nausea
Orthostatic hypotension
Proximal muscle weakness
Suddenly stopped glucocorticoid treatment
Thin skin
Obesity
History (rate of weight gain, dietary history, caloric expenditure, prescribed diet for successful weight loss...)
BMI and waist circumference
Management
BMI < 25
Counsel regarding diet/exercise to ideal BMI (23)
BMI < 30
BMI 30–35
Lipids (fasting) Glucose (fasting) Blood pressure control Make a dietary plan and follow-up, if...
BMI 35–40
BMI > 40
Try all modalities If unsuccessful, consider bariatric surgery
Thyroid stimulating hormone AM/PM cortisol Ultrasound for polycystic ovaries
Hypoglycemia
Symptoms
Confirm glucose <60 mg/dl
Diabetes
Seek contributing factors or adjust insulin dosing
Drug effect, Ethanol, Salicylates, Haloperidol, Pentamidine, Trimethoprim-sulfamethoxazole
Not known to be diabetic
Fasting glucose <45 mg/dl
Insulin >6 microU/ml
C-peptide <200 mg/dl
Exogenous insulin
C-peptide >200 mg/dl
+ Sulfonylurea screen
Sulfonylurea effect
- Sulfonylurea screen
Insulinoma
Insulin <6 microU/ml
IGF-mediated Noninsulin-mediated hypoglycemia
Postprandial hypoglycemia, Surgery, Early diabetes
Hyperglycemia
Glucose level
Postprandial
140–200 mg/dl
Impaired glucose tolerance
>200 mg/dl
Diabetes confirmed
Secondary diabetes
Investigate and treat accordingly
Type 1 diabetes E (especially if younger age or ketoacidosis)
Type 2 diabetes
Manage glucose
Target A1c <7%
Noninsulin hypoglycemics (add basal insulin if A1c >7% on two agents)
Metformin
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Sulfonylureas
Others (TZDs, gliptins,exenatide)
Insulin
Basal
NPH/glargine
Bolus
Aspart/lispro/ regular
Blood pressure
Target <130/80 mm Hg
Urinary microalbumin
Target >30 mg/g creatinin
ACE inhibitor or ARB
Lipids
LDL
Target <100 mg/dl
Statin
HDL
Target >40 mg/dl
Fibrate or nicotinic acid
Exercise
Smoking cessation, Diet (lose 10%), Exercise (30 min/day), Vaccinations
Aspirin
If age >40 yr
Yearly dilated eye examination
Fasting
>126 mg/dl
Diabetes confirmed
Secondary diabetes
Investigate and treat accordingly
Type 1 diabetes E (especially if younger age or ketoacidosis)
Type 2 diabetes
Manage glucose
Target A1c <7%
Noninsulin hypoglycemics (add basal insulin if A1c >7% on two agents)
Metformin
-
-
Sulfonylureas
Others (TZDs, gliptins,exenatide)
Insulin
Basal
NPH/glargine
Bolus
Aspart/lispro/ regular
Blood pressure
Target <130/80 mm Hg
Urinary microalbumin
Target >30 mg/g creatinin
ACE inhibitor or ARB
Lipids
LDL
Target <100 mg/dl
Statin
HDL
Target >40 mg/dl
Fibrate or nicotinic acid
Exercise
Smoking cessation, Diet (lose 10%), Exercise (30 min/day), Vaccinations
Aspirin
If age >40 yr
Yearly dilated eye examination
>100 mg/dl
Impaired fasting glucose
Pregnant
Use 3-hr OGTT or 1-hr OGTT
Hospitalized