Question of the Week

For October 6, 2020

A 47-year-old woman with poorly controlled type 2 diabetes, as well as hypertension and hyperlipidemia, reports a 1-month history of several new skin lesions. She has had no fevers, chills, or joint pain. Her current medications are insulin, metformin, labetalol, simvastatin, and a multivitamin.

The skin lesions are reddish-yellow, pruritic, and painful. They are present on the backs of both legs and on the buttocks and knees (figures 1 and 2).

Laboratory testing reveals a glycated hemoglobin level of 11.9% (reference range, 4.3–5.6). The patient’s complete blood count, electrolytes, and kidney function are normal.

Which one of the following conditions is the most likely cause of this patient’s skin lesions?

Cushing syndrome
Familial combined hypercholesterolemia

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