مشاركة medicine patients 3337.pptx

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A 32-year-old woman comes to the office due to lightheadedness. She had an uncomplicated vaginal delivery 6 weeks ago with minimal blood loss. The patient had mild fatigue and backache during the last trimester of pregnancy, but the fatigue has worsened since the delivery. She has also been having intermittent generalized abdominal pain, loss of appetite, and weakness. She says her skin is tanning even though she has spent only minimal time outdoors. Yesterday, the patient felt like she was "going to pass out" and experienced several episodes of lightheadedness accompanied by nausea and abdominal discomfort. She has no chest pain, shortness of breath, or bleeding. The patient has a history of hypothyroidism and takes levothyroxine. Her temperature is 36.1 C (97 F), blood pressure is 110/60 mm Hg supine and 85/45 mm Hg standing, and pulse is 104/min. Skin shows generalized hyperpigmentation. Lungs are clear, and her heart rate is tachycardic but regular with no gallops or murmurs. Abdominal examination shows mild, diffuse tenderness without guarding and normal bowel sounds. Laboratory results are as follows: