CHIEF COMPLAINT: CHIEF COMPLAINT: ACTH-dependent [**Location (un) 3484**] Syndrome

PRESENT ILLNESS: 76 y/o wf with PMH with breast cancer [**2091**] Rx mastectomy,
metastatic to lung (bx proven, f/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Last Name (NamePattern1) 19**]) but stable over
time on TAM (tamoxifen). Also [**2112**] dx of endometrial cancer s/p
TAH/BSO and XRT with no recurrences, and actually put back on
TAM
afterwards to prevent breast cancer spread. She is a direct
admit from [**Hospital 1800**] clinic for pituitary MRI and adrenalectomy
by Dr. [**Last Name (STitle) 3748**] early next week. She was recently diagnosed with
ACTH-dependent [**Location (un) 3484**] syndrome.

MEDICAL HISTORY: metastatic breast ca to lungs
endometrial ca-s/p tah bso and xrt
myeloproliferative disorder
htn
hyperlandipidemia
anxiety
basal cell ca face

MEDICATION ON ADMISSION: AMILORIDE - 5 mg Tablet - 2 Tablet(s) by mouth daily
ATORVASTATIN [LIPITOR] - 10 mg Tablet - [**11-29**] Tablet(s) by mouth
every other day
BRIMONIDINE [ALPHAGAN P] -  (Prescribed by Other Provider) - 0.1
% Drops - 1 OU three times a day
FUROSEMIDE - 40 mg Tablet - 1 Tablet(s) by mouth twice a day
KETOCONAZOLE - 200 mg Tablet - 1.5 Tablet(s) by mouth three
times
a day
LISINOPRIL - 40 mg Tablet - 1 Tablet(s) by mouth once a day
METFORMIN - 500 mg Tablet - 1 Tablet(s) by mouth DAILY (Daily)
METOPROLOL TARTRATE - 50 mg Tablet - 2 Tablet(s) by mouth two
times a day
SPIRONOLACTONE - 100 mg Tablet - 2 Tablet(s) by mouth twice a
day
TAMOXIFEN - 10 mg Tablet - 1 Tablet(s) by mouth twice a day
TIMOLOL MALEATE - 0.25 % Drops - 1 OU twice a day

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PHYSICAL EXAM
GENERAL: elderly woman, in NAD
HEENT: round, red cushingoid face, steri-strips covering sutures
on left side of forehead - c/d/i, bruising under left eye,
telengiectasias on both cheeks, hair growth on upper cheeks,
mouth clear with dry mucous membranes
CARDIAC: Regular rhythm, normal rate. Normal S1, S2. No murmurs,
rubs or gallops.
LUNGS: CTAB, good air movement biaterally. no wheezing/crackles.
ABDOMEN: +BS. Soft, NT, ND. No striae.  No HSM, masses.
EXTREMITIES: 3+ pitting edema symmetric and [**1-29**] of the way up to
the
knee with blistering at the ankles/feet
SKIN: dark pigmentation.
NEURO: CN 2-12 grossly intact. prox strength 5/5 deltoids, but
3+/5 for iliopsoas muscles
Mental Status: Can be irritable and easily distracted, pressured
speech

FAMILY HISTORY: An uncle who was diabetic, an aunt who had breast cancer, and a
fraternal twin who had lung cancer. She also has another sister
with myasthenia [**Last Name (un) 2902**].

SOCIAL HISTORY: She is extremely active, currently does some sculpting and goes
to classes in [**University/College **]. Lives with her husband, [**Name (NI) **]. Had some
previous cigarette smoking, but has quit many years ago.
Occasional alcohol once a month. Denies any IV
or other drug use. She has a friend who recently died and is
currently practicing to play at her funeral.
Cushing's syndrome,Acute kidney failure, unspecified,Secondary malignant neoplasm of lung,Other lymphatic and hematopoietic tissues,Unspecified essential hypertension,Malignant neoplasm of other specified sites of female breast,Personal history of malignant neoplasm of other parts of uterus,Personal history of other malignant neoplasm of skin,Acquired absence of breast and nipple,Acquired absence of both cervix and uterus,Personal history of antineoplastic chemotherapy,Personal history of irradiation, presenting hazards to health,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Hypopotassemia,Dysthymic disorder,Other and unspecified hyperlipidemia
Cushing's syndrome,Acute kidney failure NOS,Secondary malig neo lung,Lymph/hematpoitc tis NEC,Hypertension NOS,Malign neopl breast NEC,Hx-uterus malignancy NEC,Hx-skin malignancy NEC,Acq absnce breast/nipple,Acq absnce cervix/uterus,Hx antineoplastic chemo,Hx of irradiation,DMII wo cmp nt st uncntr,Long-term use of insulin,Hypopotassemia,Dysthymic disorder,Hyperlipidemia NEC/NOS
Admission Date:  [**2116-5-22**]              Discharge Date:   [**2116-6-1**]

Date of Birth:  [**2039-6-18**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 800**]
Chief Complaint:
CHIEF COMPLAINT: ACTH-dependent [**Location (un) 3484**] Syndrome

Major Surgical or Invasive Procedure:
Bilateral adrenalectomy

History of Present Illness:
76 y/o wf with PMH with breast cancer [**2091**] Rx mastectomy,
metastatic to lung (bx proven, f/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Last Name (NamePattern1) 19**]) but stable over
time on TAM (tamoxifen). Also [**2112**] dx of endometrial cancer s/p
TAH/BSO and XRT with no recurrences, and actually put back on
TAM
afterwards to prevent breast cancer spread. She is a direct
admit from [**Hospital 1800**] clinic for pituitary MRI and adrenalectomy
by Dr. [**Last Name (STitle) 3748**] early next week. She was recently diagnosed with
ACTH-dependent [**Location (un) 3484**] syndrome.

Of note, pt fell on her way to clinic last week. She went to the
ED and had sutures placed on her left forehead.

She reports recent worsening dizziness, fatigue, and swelling in
her lower extremities.

On arrival to the medical floor, patient continued to be dizzy
and fatigued. Upon questioning, patient is able to answer
questions, but gets confused and forgets easily.


Past Medical History:
metastatic breast ca to lungs
endometrial ca-s/p tah bso and xrt
myeloproliferative disorder
htn
hyperlandipidemia
anxiety
basal cell ca face

Social History:
She is extremely active, currently does some sculpting and goes
to classes in [**University/College **]. Lives with her husband, [**Name (NI) **]. Had some
previous cigarette smoking, but has quit many years ago.
Occasional alcohol once a month. Denies any IV
or other drug use. She has a friend who recently died and is
currently practicing to play at her funeral.


Family History:
An uncle who was diabetic, an aunt who had breast cancer, and a
fraternal twin who had lung cancer. She also has another sister
with myasthenia [**Last Name (un) 2902**].

Physical Exam:
PHYSICAL EXAM
GENERAL: elderly woman, in NAD
HEENT: round, red cushingoid face, steri-strips covering sutures
on left side of forehead - c/d/i, bruising under left eye,
telengiectasias on both cheeks, hair growth on upper cheeks,
mouth clear with dry mucous membranes
CARDIAC: Regular rhythm, normal rate. Normal S1, S2. No murmurs,
rubs or gallops.
LUNGS: CTAB, good air movement biaterally. no wheezing/crackles.
ABDOMEN: +BS. Soft, NT, ND. No striae.  No HSM, masses.
EXTREMITIES: 3+ pitting edema symmetric and [**1-29**] of the way up to
the
knee with blistering at the ankles/feet
SKIN: dark pigmentation.
NEURO: CN 2-12 grossly intact. prox strength 5/5 deltoids, but
3+/5 for iliopsoas muscles
Mental Status: Can be irritable and easily distracted, pressured
speech

Pertinent Results:
ADMISSION LABS ([**2116-5-22**]):
WBC-14.0* RBC-4.28 Hgb-12.9 Hct-38.5 MCV-90 MCH-30.1 MCHC-33.6
RDW-16.0* Plt Ct-239#
UreaN-51* Creat-1.8* Na-143 K-4.7 Cl-102 HCO3-28 AnGap-18
Cortsol-39.8*

PERTINENT LABS:
Serial Hct:
[**5-22**] 38.5
[**5-23**] 32.9 / 33.1
[**5-24**] 31.8 (Retic 2.4)
[**5-24**] 35.2
[**5-25**] 32.9
[**5-26**] 33.4
[**5-27**] 29

Cr:
[**5-22**] 1.8
[**5-23**] 1.8
[**5-24**] 1.8
[**5-25**] 2.0
[**5-26**] 1.9
[**5-27**] 1.4
[**5-28**] 1.3
[**5-29**] 1.0
7/4-6 0.9

K:
[**5-22**] 4.7
[**5-23**] 4.3
[**5-24**] 5.1
[**5-25**] 4.7, 6.1
[**5-26**] 5.0, 5.2, 5.1
[**5-27**] 3.6

Cortisol:
[**5-22**] 39.8
[**5-25**] 23.9

STUDIES:
MRI pituitary - no evidence of micro- or macroadenoma

PATH:
Adrenal glands - Part 1 is additionally labeled "left adrenal
gland." It consists of a fragment of yellow-tan fibroadipose
tissue containing an adrenal gland measuring overall 11.5 x 5.0
x 2.4 cm. The outer surface is inked in blue. The specimen is
sectioned to reveal a tan-brown adrenal gland measuring 6.5 x
2.2 x 1.5 cm and weighing 28 grams after the excess fat is
trimmed.  The head measures 6.0 cm in length x 0.4 cm in
diameter, the body measures 6.8 cm in length x 0.5 cm in
diameter, and the tail measures 6.4 cm in length x 0.8 cm in
diameter. The cortex measures up to 0.1 cm and is [**Location (un) 2452**]. On cut
sections, no masses or lesions are identified in the cortex or
medulla. The specimen is represented as follows: A-B = head, C-D
= body, E = tail.

Part 2 is additionally labeled "right adrenal gland." It
consists of a fragment of fibroadipose tissue containing an
adrenal gland measuring overall 7.8 x 4.5 x 1.5 cm. The outer
surface is inked in black. The specimen is sectioned to reveal a
tan-brown adrenal gland measuring 4.5 x 1.8 x 1.2 cm and
weighing 16 grams after the access fat is trimmed. The head
measures 3.5 cm in length x 0.3 cm in diameter, the body
measures 4.5 cm in length x 0.5 cm in diameter, and the tail
measures 3.5 cm in length x 1.1 cm in diameter. The cortex
measures up to 0.1 cm and is [**Location (un) 2452**]. On cut sections, no masses
or lesions are identified in the cortex or medulla. The specimen
is represented as follows: F-G = head, H-I = body, J = tail.

DISCHARGE LABS ([**2116-6-1**]):
WBC-11.7* RBC-2.97* Hgb-9.0* Hct-26.7* MCV-90 MCH-30.3 MCHC-33.7
RDW-16.3* Plt Ct-396
Glucose-73 UreaN-22* Creat-0.9 Na-143 K-3.3 Cl-109* HCO3-27
AnGap-10
Calcium-8.2* Phos-2.5* Mg-1.9

Brief Hospital Course:
Mrs. [**Known lastname **] is a 76F with severe ACTH-dependent [**Location (un) **] syndome
affecting multiple systems. Localization of ectopic sources of
ACTH unsuccessful, so she was admitted for pituitary MRI,
followed by adrenalectomy by Dr. [**Last Name (STitle) 3748**]. Final [**Location (un) 1131**] of MRI
reports no micro- or macroadenoma of the pituitary.

# [**Location (un) **] SYNDROME: The patient's dizziness and fatigue improved
over the course of her stay. LE edema also improved greatly
during the last several days. Pt was followed closely by
Endocrine.  Pt was on Ketoconazole to control her symptoms. This
was discontinued after her adrenalectomy on Wednesday [**5-27**]. Pt
was started on hydrocortisone 100mg IV q8h just prior to surgery
and weaned down after surgery to a maintenance dose of 20mg qAM
and 10mg qPM. She tolerated the surgery well, and her symptoms
improved.

# HYPERKALEMIA: The patient's K level increased to 6.2, likely
secondary to medications. She was given 2 doses of kayexalate,
and repeat K was 5. Spironolactone and amiloride were
discontinued. Subsequent K levels ranged between 3.3-4.5.

# ANEMIA: Pt's HCT fluctuated between 29-33 in the first several
days of hospitalization. Retic count 2.4. Pt reports minimal
rectal bleeding from known hemorrhoids. Pt has recent MRI head
with no evidence of bleed. Pt did not have any symptoms of acute
bleed during these episodes - no shortness of breath and no
lightheadedness. HCT remained stable after surgery, and there
was no evidence of bleeding.

# DIABETES MELLITUS: Pt was manic [**12-30**] to her disease prior to
surgery, and was unable to manage her blood glucose level at
home. She was placed on an insulin sliding scaled while in the
hospital. Glucose levels dropped after surgery. She was
discharged on metformin 500mg daily.

# HEMORRHOIDS: Pt had painful hemorrhoids, with minimal
bleeding. She was treated with Tucks hemorrhoid cream.

# ACUTE RENAL FAILURE: Pt has a baseline Cr 1.1, but was
admitted with Cr 1.8, which was as high as 2.0. This was likely
secondary to medication regimen. Lisinopril was discontinued on
admission, and spironolactone and amiloride were subsequently
d/c'd as well. As medications were discontinued, pt's Cr dropped
to normal levels. Cr level was 0.9 on discharge.

# VOLUME OVERLOAD: Edema in b/l lower extremities improved
greatly. Pt received several days of Lasix IV, which was held
when her BP dropped. She was autodiuresing on discharge.

# HYPOTENSION: The patient's blood pressure, which was initially
high prior to adrenalectomy, ran low at 90s-low 100s/50s during
her hospitalization. Lisinopril, spironolactone, and amiloride
were discontinued. Metoprolol was decreased to 25mg PO BID. The
patient's blood pressure was stable on this regimen, so she was
discharged on metoprolol 25mg [**Hospital1 **].


Medications on Admission:
AMILORIDE - 5 mg Tablet - 2 Tablet(s) by mouth daily
ATORVASTATIN [LIPITOR] - 10 mg Tablet - [**11-29**] Tablet(s) by mouth
every other day
BRIMONIDINE [ALPHAGAN P] -  (Prescribed by Other Provider) - 0.1
% Drops - 1 OU three times a day
FUROSEMIDE - 40 mg Tablet - 1 Tablet(s) by mouth twice a day
KETOCONAZOLE - 200 mg Tablet - 1.5 Tablet(s) by mouth three
times
a day
LISINOPRIL - 40 mg Tablet - 1 Tablet(s) by mouth once a day
METFORMIN - 500 mg Tablet - 1 Tablet(s) by mouth DAILY (Daily)
METOPROLOL TARTRATE - 50 mg Tablet - 2 Tablet(s) by mouth two
times a day
SPIRONOLACTONE - 100 mg Tablet - 2 Tablet(s) by mouth twice a
day
TAMOXIFEN - 10 mg Tablet - 1 Tablet(s) by mouth twice a day
TIMOLOL MALEATE - 0.25 % Drops - 1 OU twice a day

Medications - OTC
ASPIRIN - 81 mg Tablet, Delayed Release (E.C.) - 1 Tablet(s) by
mouth daily
MULTIVITAMIN -   Tablet - 1 Tablet(s) by mouth daily


Discharge Medications:
1. Pramoxine-Mineral Oil-Zinc 1-12.5 % Ointment Sig: One (1)
Appl Rectal Q6H (every 6 hours) as needed for pain.
2. Multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. Atorvastatin 10 mg Tablet Sig: 0.5 Tablet PO Q48H (every 48
hours).
4. Tamoxifen 10 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
5. Timolol Maleate 0.25 % Drops Sig: One (1) Drop Ophthalmic [**Hospital1 **]
(2 times a day).
6. Brimonidine 0.15 % Drops Sig: One (1) Drop Ophthalmic Q8H
(every 8 hours).
7. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
8. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day): for constipation.
Disp:*60 Capsule(s)* Refills:*2*
9. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
Disp:*60 Tablet(s)* Refills:*2*
10. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO BID (2 times a day).
Disp:*60 Tablet, Chewable(s)* Refills:*2*
11. Metformin 500 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
12. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
13. Hydrocortisone 10 mg Tablet Sig: 1-2 Tablets PO twice a day:
Please take 4 tablets in the morning and 2 tablets at night on
[**2116-6-1**] and [**2116-6-2**]. Then take 2 tablets in the morning and 1
tablet at night.
Disp:*100 Tablet(s)* Refills:*2*
14. Vitamin D 1,000 unit Capsule Sig: One (1) Capsule PO once a
day.
Disp:*30 Capsule(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Primary Diagnosis
[**Location (un) 3484**] Syndrome

Secondary Diagnoses
Diabetes Mellitus
Acute Renal Failure
Hypertension


Discharge Condition:
Stable, improved


Discharge Instructions:
You were treated in the hospital for worsening symptoms due to
[**Location (un) 3484**] syndrome. You had both adrenal glands removed while
you were here. The surgery went well, and you are recovering
nicely.

As your Endocrine doctors have told [**Name5 (PTitle) **], you will be on chronic
steroids. Right now, we are decreasing your dose of
Hydrocortisone slowly. You will be discharged on Hydrocortisone
40mg in the morning and 20mg at night for Monday [**6-1**] and Tuesday
[**6-2**]. Then starting Wednesday [**6-3**], you will continue on your
maintenance dose of 20mg in the morning and 10 mg at night.
You have an appointment with Dr. [**Last Name (STitle) 574**], who will give you
further instructions regarding your steroid dose. In the future,
they will likely add Florinef, which is another kind of steroid,
to your medication regimen.

The following changes have been made to your medications:
1. Ketoconazole has been discontinued since your surgery
2. You are currently only taking Metoprolol 25mg twice a day for
your blood pressure. Amiloride, Lasix, Lisinopril, and
Spironolactone have been stopped since your blood pressure is
lower now. Please see your primary care physician to monitor
your blood pressure and add medications as necessary.
3. You will be taking Metformin 500mg once a day to control your
blood sugars.
4. You are now taking Hydrocortisone for your steroid
replacement. You will take 40mg in the morning and 20mg at night
on Monday [**6-1**] and Tuesday [**6-2**]. Starting Wednesday [**6-3**], you will
take 20mg in the morning and 10mg at night.

If you have a minor illness, such as a cold or fever, you will
need to double or triple your Hydrocortisone dose (40mg in the
morning and 20mg at night, or 60mg in the morning and 30mg at
night). You will do this for 3 days, and then return to your
regular dose if you feel better. You will need a DexaPen, which
is an injection of the hydrocortison for when you cannot
tolerated medication by mouth. Please follow-up with your
Endocrine doctor to find out how to get it at the pharmacy. If
you are not able to tolerate the medication by mouth before you
get the injection, please go to the emergency department.

If you don't get better or if you have a severe illness, call
your doctor right away.

It is very important that you get a Med Alert Bracelet that you
will need to wear at all times. You can buy them at drug stores,
or online ([**URL 109461**]).

If you experience fevers, chills, worsening abdominal pain,
bleeding, lightheaded, shortness of breath, or any other
concerning symptoms, please call your primary care physician or
return to the emergency department.

It was a pleasure meeting you and participating in your care.

Followup Instructions:
Please follow-up with your primary care physician, [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) 4390**]:
Monday [**2116-6-8**] @ 10:15am
Location: [**Street Address(2) **].  [**Location (un) 620**], MA
Phone number: [**Telephone/Fax (1) 3070**]

Please follow-up with Dr. [**Last Name (STitle) 574**], [**First Name3 (LF) **] Endocrinologist
[**6-24**] @ 1pm
Phone number: [**Telephone/Fax (1) 6468**]

Please call Dr. [**Last Name (STitle) 3748**], your urologist, for a follow-up
appointment within the next 2 weeks. ([**Telephone/Fax (1) 8791**]


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 810**] MD, [**MD Number(3) 811**]
{"Cushing's syndrome,Acute kidney failure, unspecified,Secondary malignant neoplasm of lung,Other lymphatic and hematopoietic tissues,Unspecified essential hypertension,Malignant neoplasm of other specified sites of female breast,Personal history of malignant neoplasm of other parts of uterus,Personal history of other malignant neoplasm of skin,Acquired absence of breast and nipple,Acquired absence of both cervix and uterus,Personal history of antineoplastic chemotherapy,Personal history of irradiation, presenting hazards to health,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Hypopotassemia,Dysthymic disorder,Other and unspecified hyperlipidemia"}


You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT.



### Clinical text :
CHIEF COMPLAINT: CHIEF COMPLAINT: ACTH-dependent [**Location (un) 3484**] Syndrome

PRESENT ILLNESS: 76 y/o wf with PMH with breast cancer [**2091**] Rx mastectomy,
metastatic to lung (bx proven, f/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Last Name (NamePattern1) 19**]) but stable over
time on TAM (tamoxifen). Also [**2112**] dx of endometrial cancer s/p
TAH/BSO and XRT with no recurrences, and actually put back on
TAM
afterwards to prevent breast cancer spread. She is a direct
admit from [**Hospital 1800**] clinic for pituitary MRI and adrenalectomy
by Dr. [**Last Name (STitle) 3748**] early next week. She was recently diagnosed with
ACTH-dependent [**Location (un) 3484**] syndrome.

MEDICAL HISTORY: metastatic breast ca to lungs
endometrial ca-s/p tah bso and xrt
myeloproliferative disorder
htn
hyperlandipidemia
anxiety
basal cell ca face

MEDICATION ON ADMISSION: AMILORIDE - 5 mg Tablet - 2 Tablet(s) by mouth daily
ATORVASTATIN [LIPITOR] - 10 mg Tablet - [**11-29**] Tablet(s) by mouth
every other day
BRIMONIDINE [ALPHAGAN P] -  (Prescribed by Other Provider) - 0.1
% Drops - 1 OU three times a day
FUROSEMIDE - 40 mg Tablet - 1 Tablet(s) by mouth twice a day
KETOCONAZOLE - 200 mg Tablet - 1.5 Tablet(s) by mouth three
times
a day
LISINOPRIL - 40 mg Tablet - 1 Tablet(s) by mouth once a day
METFORMIN - 500 mg Tablet - 1 Tablet(s) by mouth DAILY (Daily)
METOPROLOL TARTRATE - 50 mg Tablet - 2 Tablet(s) by mouth two
times a day
SPIRONOLACTONE - 100 mg Tablet - 2 Tablet(s) by mouth twice a
day
TAMOXIFEN - 10 mg Tablet - 1 Tablet(s) by mouth twice a day
TIMOLOL MALEATE - 0.25 % Drops - 1 OU twice a day

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PHYSICAL EXAM
GENERAL: elderly woman, in NAD
HEENT: round, red cushingoid face, steri-strips covering sutures
on left side of forehead - c/d/i, bruising under left eye,
telengiectasias on both cheeks, hair growth on upper cheeks,
mouth clear with dry mucous membranes
CARDIAC: Regular rhythm, normal rate. Normal S1, S2. No murmurs,
rubs or gallops.
LUNGS: CTAB, good air movement biaterally. no wheezing/crackles.
ABDOMEN: +BS. Soft, NT, ND. No striae.  No HSM, masses.
EXTREMITIES: 3+ pitting edema symmetric and [**1-29**] of the way up to
the
knee with blistering at the ankles/feet
SKIN: dark pigmentation.
NEURO: CN 2-12 grossly intact. prox strength 5/5 deltoids, but
3+/5 for iliopsoas muscles
Mental Status: Can be irritable and easily distracted, pressured
speech

FAMILY HISTORY: An uncle who was diabetic, an aunt who had breast cancer, and a
fraternal twin who had lung cancer. She also has another sister
with myasthenia [**Last Name (un) 2902**].

SOCIAL HISTORY: She is extremely active, currently does some sculpting and goes
to classes in [**University/College **]. Lives with her husband, [**Name (NI) **]. Had some
previous cigarette smoking, but has quit many years ago.
Occasional alcohol once a month. Denies any IV
or other drug use. She has a friend who recently died and is
currently practicing to play at her funeral. 

### Response:
{"Cushing's syndrome,Acute kidney failure, unspecified,Secondary malignant neoplasm of lung,Other lymphatic and hematopoietic tissues,Unspecified essential hypertension,Malignant neoplasm of other specified sites of female breast,Personal history of malignant neoplasm of other parts of uterus,Personal history of other malignant neoplasm of skin,Acquired absence of breast and nipple,Acquired absence of both cervix and uterus,Personal history of antineoplastic chemotherapy,Personal history of irradiation, presenting hazards to health,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Hypopotassemia,Dysthymic disorder,Other and unspecified hyperlipidemia"}
