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5mo
case study

Patient Background: A 75-year-old woman presents with progressive weight loss, generalized weakness, easy bruising, and poorly controlled hypertension. On exam, she has thin skin with ecchymoses, proximal muscle weakness, and hypokalemia (serum potassium 2.9 mmol/L).

Family History: The patient reported no family history of hormonal disorders, malignancy, or pituitary pathology relevant to her presentation.

Assessment and Diagnosis: Evaluation revealed elevated 24-hour urinary free cortisol (UFC), elevated morning (8 am) serum cortisol, and non-suppression on a low-dose dexamethasone suppression test (LDDST), with elevated ACTH. Pituitary MRI was negative, and Ga-68 DOTATATE PET/CT showed no ectopic lesion. Bilateral inferior petrosal sinus sampling (BIPSS) with CRH stimulation confirmed MRI-negative, ACTH-dependent Cushing’s disease, although features such as marked weight loss and hypokalemia initially raised suspicion for ectopic ACTH secretion.

Suggested treatment plan: The patient declined surgery and opted for medical therapy with an adrenal steroidogenesis inhibitor plus a dopamine agonist.

Patient education: The patient was educated on the importance of medication adherence and avoidance of drug–drug interactions. She was specifically advised to avoid concurrent use of gastric acid–reducing agents, which can impair treatment absorption and effectiveness.

Follow-up: Medical therapy led to normalization of UFC, improved potassium levels, blood pressure, and glycemic control, along with a 15-lb weight gain. A relapse occurred after initiation of an acid-suppressing medication, which compromised drug absorption. Discontinuation restored efficacy, with rapid normalization of hormone levels and a 50-lb weight gain, improving mobility and strength.

  1. What clinical features in this case suggested ectopic ACTH over typical Cushing’s disease? Answer Severe hypokalemia and marked weight loss suggested ectopic ACTH, unlike the usual weight gain in pituitary Cushing’s disease.
  2. Given the MRI-negative status, what key test confirmed Cushing’s disease and ruled out ectopic ACTH? Answer Bilateral inferior petrosal sinus sampling (BIPSS) showed a post-CRH central-to-peripheral ACTH ratio >3, confirming a pituitary source of ACTH despite negative imaging.
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5mo
Exercise training modestly improves lipid profiles in dyslipidaemia

Dyslipidaemia is a modifiable risk factor for cardiovascular disease (CVD). A large meta-analysis shows that exercise training (ExTr) yields modest but significant improvements across lipid outcomes.

ExTr reduced total cholesterol (−5.9 mg/dL), LDL (−7.2 mg/dL), triglycerides (−8.0 mg/dL), VLDL (−3.9 mg/dL), and increased HDL (+2.1 mg/dL). Combined aerobic training (AT) and resistance training (RT) produced the most consistent lipid improvements. AT alone improved all five markers, while RT primarily raised HDL.

Meta-regression showed dose–response effects: each additional AT session per week was associated with a reduction in TC of −7.7 mg/dL, and longer sessions (>30 minutes) improved HDL. These findings support tailoring exercise to lipid profiles.

ExTr alone may reduce LDL by ~6.3%, corresponding to a potential 4–5% reduction in ASCVD risk. When combined with pharmacologic therapy, total risk reduction may approach 30%.

However, up to 37% of included studies showed no benefit for certain lipid subtypes, underscoring individual variability. Still, 100% of studies reported benefit for VLDL. Exercise should remain a first-line strategy for dyslipidaemia, with tailored prescriptions using AT and RT. AT should be prioritized in cases of hyperlipidaemia.

How will you incorporate these exercise-specific insights into your dyslipidaemia counselling strategies?

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5mo
Obesity-Related Glomerulosclerosis-How Adiposity Damages the Kidneys - PubMed

Obesity-Related Glomerulosclerosis-How Adiposity Damages the Kidneys - PubMed

Source : https://pubmed.ncbi.nlm.nih.gov/40650024/

Obesity, hypertension, and chronic kidney disease (CKD) constitute the deadly trinity of modern threats for populations of both developed and developing countries. These diseases (together with type 2 diabetes) are...

Obesity, hypertension, and CKD interlink, driving cardiovascular morbidity. Obesity-related glomerulosclerosis arises via inflammatory, compressive, and hemodynamic mechanisms; weight loss, GLP1 agonists, and bariatric surgery offer promising kidney-protective strategies.

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6mo
Obesity and its management in primary care setting - PubMed

Obesity and its management in primary care setting - PubMed

Source : https://pubmed.ncbi.nlm.nih.gov/40305970/

Obesity is a worldwide epidemic affecting adults and children, regardless of their socioeconomic status. Significant progress has been made in understanding the genetic causes contributing to obesity, shedding light on...

Obesity impacts all ages globally, causing serious complications. Prevention, especially in children, and treatment through lifestyle, surgery, and new drugs like GLP-1RAs are crucial, with primary care central.

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6mo

The GLP-1 agonists work very well. The major problem is Insurance, not covering it to many many people who would benefit from it. It’s heartbreaking to keep this life altering medication from them due to lack of financial resources and lack of insurance coverage.

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