Endocrinology

Numerous brown spots on the leg of a man with longstandingdiabetes are diabetic dermopathy. This is amicroangiopathy of the small arterioles of the legs, whichresults in atrophic brown papules.

The atrophic patches on the lower legs of this 47-year-old woman who has haddiabetes mellitus for over 20 years are those of necrobiosis lipoidica diabeticorum.These areas involve degeneration of collagen and elastic fibers in thelower dermis and changes in blood vessel walls. The lesions usually begin assingle or multiple elevated reddish nodules, most commonly in the pretibialarea. Over time, they expand and coalesce into distinctive brownish yellowpatches. These areas may be somewhat tender, but as they spread, theyfrequently become painless-unless they ulcerate. Because the involved skinis fragile, ulcers can form after any minor trauma.

Migraine is an episodic, often debilitatingcondition that affects women moreoften than men. Twenty-eight millionAmericans suffer from migraineheadaches-and nearly 75% of theseare women.1 Unlike other chronic painconditions, migraine has its peakprevalence during the years of greatestproductivity, when most women arejuggling family responsibilities andcareers.2 Many women are particularlysusceptible to migraine attacks justbefore and during menses.

For 3 days, a 23-yearold woman had been bothered by pruritic vaginal and vulvar lesions. A cheesy white vaginal discharge was associated with the itching. She denied being sexually active.

A boy was born to a gravida 2, para 1, 26-year-old woman at 37 weeks’ gestation. The pregnancy had been complicated by gestational diabetes. The infant was delivered vaginally; Apgar scores were 6 at 1 minute and 9 at 5 minutes.

Levofloxacin, 500 mg/d, had been prescribed for a 74-year-old woman who had a urinary tract infection. The patient had type 2 diabetes and hypertension. She was allergic to sulfa drugs. Two hours after taking the first oral dose of the antibiotic, painful blisters developed on the lower lip and soft palate.

Patients with diabetes who find repeated pricking of the fingertipspainful can obtain glucose readings by pricking their earlobe.

Concerned about a lesion between her eyes, a 91-year-old woman sought medical evaluation. She had not seen a physician for 23 years. The patient was strong-willed and alert, with no evidence of Alzheimer disease. A huge goiter was evident.

Although the cardiovascular death ratehas declined in the United States, thenumber of hospitalizations for cardiacdisease has not. The improvement incare has been offset by an increase inthe number of older Americans. By2050, more than 100 million Americanswill be 60 years of age or older,and about 30 million will be older than80 years.

A 46-year-old woman with type 1 diabetes mellitus presented to the emergency department with wheals, flares, and severe pruritus of her face and trunk.

This patient has a 2-year history of red plaque with a yellow atrophic center on the leg, which has ulcerated over the past 3 months.

These velvety, hyperpigmented plaques are secondary to acanthosis nigricans, a common problem in patients with insulin-resistant states.

Hundreds of yellow papules developed on the trunk and extremities of this patient, whose diabetes was uncontrolled.