Differentials
Hypothyroidism, primary
SIGNS / SYMPTOMS
Fatigue, depression, cold intolerance, excessive sleepiness, dry/coarse hair, constipation, dry skin, muscle cramps, decreased concentration
INVESTIGATIONS
Free thyroxine (T4): low.
Thyroid-stimulating hormone (TSH): elevated.
Hypothyroidism, central
SIGNS / SYMPTOMS
Fatigue, depression, cold intolerance, excessive sleepiness, dry/corse hair, constipation, dry skin, muscle cramps, decreased concentration
INVESTIGATIONS
Free thyroxine (T4): low.
Thyroid-stimulating hormone (TSH): inappropriately low or normal.
Cushing syndrome
SIGNS / SYMPTOMS
Central obesity, moon facies, striae, hirsutism, lipodystrophy, hypertension, diabetes, depression
INVESTIGATIONS
Urinary free cortisol level: >50 micrograms/24 hours; low-dose dexamethasone suppression test: morning serum cortisol >1.8 micrograms/dL; the presence of obesity may give false-positive results. If suspected, should be confirmed with further testing.
Lipedema
SIGNS / SYMPTOMS
Distinct distribution of pathologic tissue that differs from non-lipedema obesity with disproportionately increased adipose tissue of lower extremities and, in some cases, of arms. The trunk, hands, and feet are spared.[94] Occurs almost exclusively in females at times of hormonal change (e.g., puberty, childbirth, menopause).[94] Associated with tissue tenderness and easy bruising.[94][95] Positive family history in around 60%.[95] Lipedema tissue is resistant to reduction by diet, exercise, or bariatric surgery.[94]
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