Differential Diagnosis I: Hypothyroidism
Rationale: The patient’s description of symptoms, past medical history, and the findings on clinical examination provide rationale for the presence of hypothyroidism. Also, with the knowledge that hypothyroidism is most common in women and people of older age, this patient’s gender and age place her at a higher risk for this disorder (McCance & Huether, 2014). The patient presents with general fatigue, weakness, and slow wound healing (an abrasion on right ankle that won’t heal). The patient has a history of hyperlipidemia and hypertension. On clinical finding, this patient has elevated serum lipid levels, a lowered basal body temperature (94.3), and cool and dry skin. A blood test measuring TSH and TH (total T3 and both total and free T4) levels should be performed to confirm the diagnosis of hypothyroidism. An increased level of TSH and a decreased level of TH would indicate a diagnosis of hypothyroidism (McCance & Huether, 2014).
Differential Diagnosis II: Cushing Syndrome
Rationale: The patient’s recent history of overall fatigue, weakness, sinusitis-like symptoms, and two back-to-back yeast infections could indicate a weakened immune system and that the patient has a high susceptibility for infection. In addition, the patient complains of an abrasion on her right ankle that won’t heal, indicating poor wound healing in association with a weakened immune system. A suppressed immune system and increased susceptibility to infections may indicate Cushing syndrome, since cortisol levels are chronically elevated in patients with this disorder. The patient also complains of polyuria, which is associated with Cushing syndrome as a result of cortisol-induced insulin resistance (McCance & Huether, 2014). Additionally, the patient has truncal obesity, but has been clinically diagnosed with obesity since the age of 38 and no recent weight gain has been stated in her chart. Ms. Yazzie does not appear to have increased body or facial hair and acne is absent on clinical examination, which are both indicators of Cushing syndrome (McCance & Huether, 2014). Also, the absence of excess adipose tissue in the cervical and facial regions make the diagnosis of Cushing syndrome less likely. A 24 hour urine collection, blood test, or saliva test measure cortisol levels in the body and are used to diagnosis Cushing syndrome. High levels of cortisol in the body is suggestive of the diagnosis of Cushing syndrome (McCance & Huether, 2014).
Differential Diagnosis III: Metabolic Syndrome
Rationale: The patient’s past medical history and the clinical laboratory findings provide rationale for the presence of metabolic syndrome. In order for a patient to be diagnosed with metabolic syndrome, three of the following five criteria need to be present: increased waist circumference ( >35 inches for women), plasma triglycerides ≥150 mg/dL, low plasma HDL cholesterol ( <50 mg/dL for women), blood pressure ≥ 130/85 mmHg, and fasting plasma glucose ≥ 100 mg/dL (McCance & Huether, 2014). The patient meets all five of the criteria used to diagnose metabolic syndrome, but the patient has other symptoms that are not congruent with this disorder, including visual changes, changes in urination, increased thirst, and indications of a suppressed immune system, such as fatigue, weakness, back-to-back yeast infections, and poor wound healing. There seems to be something more going on here other than metabolic syndrome and therefore, this should be evaluated as a concurrent condition. Metabolic syndrome is strongly associated with the development of type 2 diabetes mellitus (T2DM), and those with this condition should be screened on a regular basis for T2DM (McCance & Huether, 2014).