Endo Case Challenge: A 36-Year-Old Has Cramping, Lung Issues and Can’t Lose Weight

Romesh Khardori, MD, PhD


March 31, 2022

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.


A 36-year-old man presents with fatigue, increased thirst, and leg cramps for the past several months. He reports feeling warm and having cough with expectoration for the past 10 days.

He was recently informed that he has diabetes and hypertension (blood pressure, 140/90 mm Hg) and was advised to watch his diet, lose weight, and check weekly fasting blood glucose levels. He was placed on metformin (500 mg twice daily). His fasting blood glucose level has steadily increased; 4 months prior, his glycated hemoglobin level was 8.3%. Insulin glargine (30 U at bedtime) was added to his treatment protocol.

He does not report any other medical problems and is a nonsmoker. He also states that he is not able to lose weight, despite his efforts.


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