Endocrinology

Concerned about a lesion between her eyes, a 91-year-old woman sought medical evaluation. She had not seen a physician for 23 years. The patient was strong-willed and alert, with no evidence of Alzheimer disease. A huge goiter was evident.

Although the cardiovascular death ratehas declined in the United States, thenumber of hospitalizations for cardiacdisease has not. The improvement incare has been offset by an increase inthe number of older Americans. By2050, more than 100 million Americanswill be 60 years of age or older,and about 30 million will be older than80 years.

A 46-year-old woman with type 1 diabetes mellitus presented to the emergency department with wheals, flares, and severe pruritus of her face and trunk.

This patient has a 2-year history of red plaque with a yellow atrophic center on the leg, which has ulcerated over the past 3 months.

These velvety, hyperpigmented plaques are secondary to acanthosis nigricans, a common problem in patients with insulin-resistant states.

Hundreds of yellow papules developed on the trunk and extremities of this patient, whose diabetes was uncontrolled.