From the Research
For new stretch marks in a young, non-obese, non-pregnant woman, I recommend a focused evaluation to identify potential underlying causes, prioritizing investigations that could impact morbidity, mortality, and quality of life. Initial investigations should include a comprehensive medical history focusing on recent weight changes, medication use (particularly corticosteroids), and family history of connective tissue disorders. Laboratory tests should include morning cortisol levels, ACTH stimulation test if Cushing's syndrome is suspected, thyroid function tests (TSH, free T4), and possibly screening for Cushing's syndrome with a 24-hour urinary free cortisol or overnight dexamethasone suppression test 1. Consider testing for Marfan syndrome if there are other suggestive features like joint hypermobility or tall stature. Evaluate for polycystic ovary syndrome with testosterone levels and pelvic ultrasound if there are other signs like irregular periods or hirsutism. These investigations are important because unexplained stretch marks in this demographic may signal underlying endocrine disorders, particularly hypercortisolism, which requires timely diagnosis and management 2. While stretch marks themselves are benign, identifying and treating any underlying condition is essential for the patient's overall health, as it can significantly impact their morbidity, mortality, and quality of life.
Some key points to consider in the evaluation process include:
- The clinical utility of thyroid function tests, including the potential pitfalls in their interpretation 3, 1.
- The importance of considering the clinical context when interpreting laboratory results, especially in conditions like pregnancy or critical illness 1.
- The role of biochemical testing in the diagnosis and management of thyroid disorders, including the use of TSH, free thyroxine, and thyroid autoantibodies 2.
Given the potential for significant impact on the patient's health, it is crucial to prioritize a thorough and targeted diagnostic approach to identify any underlying conditions that may be contributing to the development of new stretch marks in a young, non-obese, non-pregnant woman.