A 34-year-old female social worker presents to an ambulatory care center for evaluation of a 3-month history of fatigue, weight gain, and difficulty standing from a seated position. She states she is otherwise healthy, but she does not have a primary care physician and has not had a physical examination since her last pregnancy 12 years ago.
She has had oligomenorrhea since adolescence, and attempted pregnancy for 4 years before conceiving. She is on no medications.
On physical examination, blood pressure is 160/110 mmHg. Facial plethora was confirmed based on her driver’s license photo from 3 years ago.
Prominent abdominal obesity is present without cutaneous striae. There is no hirsutism. Preliminary laboratory testing shows mild hypokalemia and hyperglycemia. The pregnancy test was negative.