Diagnostic Surrender in a CPC

In fruitlessly seeking a physical cause for lifelong severe obesity in a 15 year old girl (Case 31-2006), the diagnostic evaluation abruptly ended with a sentence unusual in a Case Record: “Symptoms of the most common, well-defined obesity syndromes [3 are named] were absent.”

Such a statment suggests diagnostic surrender. Should physicians entertain only common, well-defined syndromes? Or limit differential diagnoses to three conditions? Or ignore signs? Or require textbook symptoms before testing for syndromes? Is not obesity a symptom of obesity syndromes? Were not the patient’s striae, hypertension, and obesity sufficient to consider Cushing syndrome? And should not the symptoms and signs of obesity syndromes be included as pertinent negatives in the case presentation?

With all these considerations unaddressed, perhaps diagnosis was only a secondary focus in the case discussion. Nevertheless, in a patient with life-threatening disease, as this patient’s obesity assuredly is, aggressive diagnostic evaluation is warranted. It is unclear whether she received it.