A 37-year-old woman presents to her GP with weight gain and hypertension. Her diagnosis of Cushing’s syndrome is discussed.
Julie presents with nonspecific symptoms, but her blood pressure reading taken in the emergency department is significantly elevated and requires further attention. The differential diagnoses for an elevated blood pressure are broad and include essential hypertension and secondary hypertension from renal, endocrine or medication-related causes. The headache history could be related to her elevated blood pressure, and further history taking would assist in delineating between primary causes of headache (migraine, tension, cluster) and secondary causes (intracranial infection, haemorrhage, tumour, temporal arteritis, medication overuse). The chronic nature of the headache makes infection or acute haemorrhage unlikely. She also has a history of two metatarsal fractures sustained with minimal trauma, raising the possibility of osteoporosis.