31-year-old woman with nausea and increased thirst

Review of Systems

  • General: Patient complains of lethargy and an increased thirst causing her to drink 3 to 4 liters of water per day. Her weight has not changed, and she has had no fever.

  • Skin: She reports mild generalized pruritus but no rash or lesions.

  • HEENT: Noncontributory

  • Pulmonary: She has no shortness of breath or cough.

  • Cardiovascular: Noncontributory

  • Gastrointestinal: Continuous nausea which is worse in the mornings but no vomiting.

  • Genitourinary: She passes urine every 1 to 2 hours including during night time. No dysuria or urinary urgency. Last normal menstrual period 3 weeks ago.

  • Musculoskeletal: No pain or swelling in joints or extremities, no back or neck pain.

  • Neurologic: Mild generalized muscle weakness for 1 week. No difficulty seeing, speaking, swallowing, or walking. No numbness or paresthesia.

  • Psychiatric: Patient's husband reports the patient has recently developed labile mood with frequent episodes of depression and reduced concentration.