Weight gain

Question 1

Key history in weight gain

Answer 1

Amount
Duration
Timing (medication changes, smoking cessation, depression)
Diet history
Hypothyroid symptoms (fatigue, constipation, skin/hair/nail changes)
Menstrual irregularity, hirsutism
Medical history
Alcohol and drug use

Question 2

Key physical exam in weight gain

Answer 2

Vital signs
Complete physical exam, including signs of Cushing’s syndrome (HTN, central obesity, moon face, buffalo hump, supraclavicular fat pads, purple abdominal striae)
Edema due to water retention in renal disease

Question 3

44 yo F with > 25 pound weight gain over last two months
+ quit smoking three months ago
+ on amitriptyline for depression
+ cold intolerance and constipation

Answer 3

Weight gain due to smoking cessation
Drug side effect
Hypothyroidism
Cushing’s syndrome

CBC, electrolytes, glucose, TSH, 24-hour urine free cortisol, dexamethasone suppression test

Question 4

30 yo F with weight gain over last three months
+ tremor, palpitations, anxiety and hunger relieved by eating
+ proximal muscle weakness and easy bruising

Answer 4

Insulinoma
Reactive postprandial hypoglycemia
Cushing’s syndrome

Blood glucose and plasma insulin
Glucose tolerance test
24-hour urine free cortisol