Endocrinology

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.