Obesity clinical presentation

True Cushing s syndrome also must be distinguished from other conditions that share some clinical presentations (as well as elevated plasma cortisol concentrations), such as depression, alcoholism, obesity, and chronic illness—the so-called pseudo-Cushing s states. 

A 62-year-old obese woman presents to your clinic complaining of deep, aching pain in her right knee. The pain is provoked by walking and subsides with rest. She also notes that her knee is difficult to bend for 1 0 minutes after rising in the morning. The symptoms have worsened over the last several years. Your interview also reveals that she injured her knee several years ago getting out of a car. 

Renal carcinoma continues to be a major cause of morbidity and mortality worldwide (Table 16.12). Last year, approximately 54,000 new renal tumor patients were diagnosed and 13,000 deaths were ascribed to renal cancer in the United States. Renal cell carcinoma (RCC) is the seventh most common neoplasm in American males and the ninth most common neoplasm in females. There is a twofold to threefold male predominance of RCC incidence but no obvious racial predilection. Recognized risk factors include tobacco smoking, obesity (body mass index >29 may double the risk of RCC) and acquired or hereditary polycystic diseases. The classic clinical presentation symptom triad of flank pain, hematuria, and palpable mass is no longer the... 

Although most notable in Stein-Leventhal syndrome, which comprises the classical findings of amenorrhea, hirsutism, obesity, and sclerotic ovaries, a wide range of clinical presentations exist. Only one-quarter to one-half of the patients present the classical signs. Usually, infertility is the leading clinical problem of patients with PCOS. Recently, ultrasonographic studies reported a prevalence of polycystic ovaries in young women of at least 20%. However, there seems to be an overlap of polycystic ovaries and normal ovaries [62]. 

A 62-year-old obese female with a history of diabetes and hypertension presents to clinic for routine follow-up. Her fasting blood sugars have been elevated recently, averaging 1 80 to 250 mg/dL (1 0 to 13.8 mmol/L). 

GW is a 61 -year-old man who presents to your clinic with a chief complaint of abdominal discomfort and cramping for the past 3 weeks not relieved with over-the-counter medications. While obtaining your medical history, he states that he also has seen small amounts of blood in his stool on and off for 4 months. He has a past medical history positive for hypertension and obesity. He states that he has smoked 1 pack of cigarettes per day for the past 40 years and drinks 4 to 6 beers every couple of days. 

Dyslipidemia is a common accompaniment of the lipodystrophy syndrome observed in HIV-infected patients. This syndrome presents as a combination of peripheral lipoatrophy and the metabolic syndrome (central adiposity, insulin resistance, and dyslipidemia). The term lipodystrophy syndrome was first used in two case reports to describe a clinical picture of subcutaneous fat wasting in the face and limbs of HIV infected patients treated with indinavir, reminiscent of the rare congenital lipodystrophy syndromes (138,139). In addition, benign symmetric lipomatoses on the trunk and neck were described. A systematic study of this syndrome in the Australian HIV cohort showed co-existence of peripheral lipoatrophy with abdominal visceral obesity, dyslipidemia, and insulin resistance in HIV-infected patients with or without treatment with protease inhibitors (140). 

Several recent reviews describe in greater detail the different pharmacological treatments for obesity and the clinical efficacies of both old and new agents (34-36). Worldwide and U.S. sales of selected drugs used for the treatment of eating and body weight disorders are presented in Table 15.8 (37). 

Although many behavioral and pharmacological interventions known to reduce the risk of clinical cardiovascular events have been linked to lower hsCRP values, it is not definitely known at present whether the lowering of hsCRP will necessarily lead to a reduction in vascular events. For example, a reduction not only in hsCRP but also in several proinflammatory cytokines and adhesion molecules was seen in obese premenopausal women assigned to a weight-loss program as compared with women in the control group. Whether these effects translate into a reduced risk of subsequent cardiovascular events has not yet been elucidated. 

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