What is the cause of persistent piloerection (excessive hair standing) of the arms for over a week, accompanied by striae (stretch marks) on the upper thighs and arms, not attributed to skin expansion?

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Differential Diagnosis

  • Single most likely diagnosis
    • Cushing's syndrome: This condition, characterized by an excess of cortisol, can lead to skin changes such as striae (stretch marks) and potentially piloerection due to the hormonal imbalance affecting the body's hair growth and skin integrity.
  • Other Likely diagnoses
    • Hyperthyroidism: An overactive thyroid gland can cause changes in skin and hair, including piloerection and potentially striae due to rapid growth and changes in skin elasticity.
    • Anabolic steroid use: The use of anabolic steroids can lead to skin changes, including striae, due to rapid muscle growth and changes in skin elasticity, and potentially piloerection due to hormonal imbalances.
  • Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
    • Pheochromocytoma: A rare tumor of the adrenal gland that can cause excessive production of adrenaline, leading to various systemic effects. While less likely, it's crucial to consider due to its potential severity and the fact that some of its symptoms, like skin changes, could be overlooked.
    • Adrenal insufficiency: Although less common, adrenal insufficiency can lead to changes in skin and hair, and missing this diagnosis could have severe consequences, including adrenal crisis.
  • Rare diagnoses
    • Ehlers-Danlos syndrome: A group of disorders that affect connective tissues supporting the skin, bones, blood vessels, and many other organs and tissues. While it could explain the striae, it's less likely to be directly associated with constant piloerection.
    • Sjögren's syndrome: An autoimmune disorder that can affect various parts of the body, including the skin, but it's less commonly associated with the specific combination of piloerection and striae not due to skin expansion.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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