A 12-year-old Hispanic female presents to the local
emergency room with seizures and severe hypertension.
Over the past year, she gained 15 kilograms, with no changes
in her appetite or level of physical activity, yet she stopped
growing in height. Her BMI increased from 21.9 to 29 kg/m2.
She was recently diagnosed with type 2 diabetes mellitus
and was treated with metformin and diet modification. Her
mother noticed that she was more impatient and irritable in the
last 4–5 months. Significant findings on her physical exam
included severe acne (face, chest, and back); acanthosis
nigricans; hirsutism; wide purple striae on legs, abdomen,
trunk; facial plethora; fat pads in supraclavicular, temporal,
and dorsocervical areas; scattered petechiae on arms and shins;
proximal muscle weakness; tinea versicolor; candida albicans;
Tanner V pubic hair and Tanner II breast development. Her
blood pressure remained N 90% for age–height, even with
treatment with three antihypertensive medications.