A 49-year-old man has had increasing knee and hip pain for the past 10 years. The pain is worse at the end of the day. During the past year, he has become increasingly drowsy at work. His wife complains that he is a "world class" snorer. During the past month, he has experienced bouts of sharp, colicky, right upper abdominal pain. On physical examination, his temperature is 37degC, pulse is 82/min, respirations are 10/ min, and blood pressure is 140/85 mm Hg. He is 175 cm (5 feet 8 inches) tall and weighs 156 kg (body mass index 51). Laboratory findings show glucose of 139 mg/dL, Hb A1c of 10, total cholesterol of 229 mg/dL, and HDL cholesterol of 33 mg/dL. An arterial blood gas measurement shows pH of 7.35; PCO2, 50 mm Hg; and PO2, 75 mm Hg. Which of the following additional conditions is most likely present in this man?
Morbid obesity can be associated with complications that include obesity hypoventilation syndrome, probable sleep apnea, glucose intolerance, cholelithiasis, and osteoarthritis. Macrovesicular steatosis with hepatomegaly is seen in obesity and may even progress to cirrhosis. Weight gain owing to hypothyroidism, which could occur in Hashimoto thyroiditis, is modest and does not lead to morbid obesity. An "obesity cardiomyopathy" resembles dilated cardiomyopathy, but not hypertrophic cardiomyopathy, which typically involves the interventricular septum with myofiber disarray. Laryngeal papillomatosis, which produces airway obstruction (without snoring), occurs more often in children and is not associated with obesity. The blood gas findings in this case could be seen in emphysema, which is not a complication of obesity; panlobular emphysema is much less common than the centrilobular emphysema associated with smoking. Rheumatoid arthritis tends to involve small joints first, and there is no relationship to obesity.
Hashimoto thyroiditis
Hypertrophic cardiomyopathy
Laryngeal papillomatosis
Nonalcoholic fatty liver disease
Misc.