Obesity due to a serious illness: a case of diagnosis and treatment


A mother brought her daughter to the clinic. The girl complained about being overweight. Diets didn’t help her lose weight.

In addition to weight issues, the patient was concerned about weakness, apathy, excessive hair loss on the head, thirst, thinning skin, frequent bruises, menstrual cycle irregularities, and increased body hair.

Any physical activity was accompanied by increased blood pressure and shortness of breath.

Medical history

At the age of 13, the girl began gaining weight rapidly. She visited endocrinologists in various clinics with her mother: private and public. The prescribed diets didn’t help her, and she found it difficult to move a lot due to muscle weakness, headaches, and apathy.

The patient was born with normal height and weight from the first pregnancy, which was uncomplicated. She became chubby at the age of 7 due to dietary errors.

She received vaccinations according to the national schedule. There were no traumas or surgeries. She rarely fell ill. She wasn’t on any regular medical checkups.


During an online consultation, the girl was very reluctant to show her face. It immediately seemed round to me. I asked the mother to send a photo taken 1–2 years ago. When I saw the pictures, I realized that her face had changed. Therefore, I invited the girl and her mother for an in-person examination at the municipal clinic. They needed to come urgently, the next day after the consultation, as I was leaving for vacation the day after.

During the in-person examination, it turned out that the girl’s face was indeed round. Numerous acne-like eruptions were visible on her face and body. The obesity was of the upper type (fat accumulated around the abdomen and above). Posture was affected. Arms and legs were thin, with no fat tissue on the thighs.

I was struck by the stretch marks (striae) of bright red or even purple color on the abdomen (like “devil’s horns”), as well as on the chest, arms, and legs. I immediately remembered a picture from an endocrinology textbook.

The next day after the examination, I needed to go to my family, but I couldn’t leave the girl without further examination for a whole month, so I made a diagnostic plan for her, and we continued communicating online.

The patient needed to undergo:
• blood tests for TSH, cortisol, ACTH, and insulin;
• biochemical blood analysis to determine glucose, cholesterol, AST, ALT, and alkaline phosphatase levels;
• adrenal ultrasound.

After 2 days, I evaluated the test results:
• cortisol was high;
• ACTH was below normal;
• Ultrasound showed a round formation in the right adrenal gland.
In connection with this, I recommended performing a dexamethasone suppression test, i.e., taking 1 mg of dexamethasone at 23:00 and fasting blood cortisol analysis the next morning at 08:00–09:00: the result was positive (cortisol level was elevated).

After that, I referred the girl for adrenal CT scan: the examination confirmed the presence of a neoplasm. Then I advised her to consult the chief pediatric endocrinologist of the city.

All examinations took 14 days.


Hormonally active adrenal neoplasm. Cushing’s syndrome. Secondary obesity (associated with an adrenal tumor).


When I returned from vacation, the patient had already been operated on: a week after the examinations, her adrenal gland was removed.

In the first year after treatment, the girl was troubled by low blood pressure, weakness, low mood, and poor appetite. Therefore, therapy included small doses of prednisolone with gradual tapering.

A year later, the girl lost weight, her menstrual cycle normalized, acne disappeared, she gained strength, blood pressure normalized, and appetite improved. She returned to school and continued her studies.

Two years after the operation, the girl became simply beautiful. It seems to me, even better and more beautiful than before. Everything is fine with her, she is finishing the 11th grade. The only downside is the scars from numerous stretch marks, but now everything is fixable.

The patient liked being slim so much that she started following a diet constantly. She goes to the gym, tolerates physical activity well. Her mood improved, but the girl herself is very serious, with a bunch of plans for life.


This case shows that examination is a very important part of the consultation. Before this, the girl was not fully examined (not undressed), so it was not possible to make the correct diagnosis. Although any doctor would have suspected the cause of the complaints if they had seen the patient. But, unfortunately, this stage of diagnosis was missed.