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Cushing Syndrome: Endocrine System

Topic1: Endocrine system 

The following is a case study with four questions. You are required to respond to TWO questions. Your response to each question should not exceed 250 words, and the length of the entire assignment is 500 words. Assignments are due at midnight. Any assignment submitted after midnight NT time, will incur a daily penalty. 

Sara Haines Cushingsyndrome case study 

Sara Haines is a 38-year-old who runs Grand Central Restaurant at Toowoomba shopping centre. She presented to St Vincent's Private Hospital, Toowoomba complaining of drastic weight gain over six months, significant facial hair growth, menstrual abnormalities, and both excessive thirst and appetite. Recently, Sara also feels dull and depressed, does not have much energy, and has stopped performing all her favourite activities including tennis at Action Indoor Sports Stadium. 

Sara is a successful and busy business person in Toowoomba, never smoked and only consumes alcohol in moderation at social events. She has several allergies (House dust mites, cockroaches, and dog's dander) and is not taking any medications other than a daily multivitamin tablet and betamethasone (as needed) for her asthma (used for many years). On clinical examination, the clinician, Dr John Smith noticed protuberant with striae and minimal bruising in her abdomen, and no abdominal tenderness, and both upper and lower extremities show areas of hyperpigmentation. Laboratory results confirmed that her cortisol levels were high indicating Cushing syndrome. 

Answer only TWO questions  

1. Explain the causative factors and pathophysiology of Cushing syndrome and how she developed this condition. 2. Describe the primary signs and symptoms of Cushing syndrome. 3. What aspects of her clinical history place Sara at increased risk of hypertension and, briefly explain the difference between Graves' disease and Cushing syndrome. 4. What treatment and follow up options are there for her condition? 

Assignment 1- 

Sara Haines Cushing syndrome case study

Topic1: Endocrine system 

The following is a case study with four questions. You are required to respond to TWO questions. Your response to each question should not exceed 250 words, and the length of the entire assignment is 500 words. Assignments are due at midnight. Any assignment submitted after midnight NT time, will incur a daily penalty. 

Sara Haines Cushing syndrome case study

 Sara Haines is a 38-year-old who runs Grand Central Restaurant at Toowoomba shopping centre. She presented to St Vincent's Private Hospital, Toowoomba complaining of drastic weight gain over six months, significant facial hair growth, menstrual abnormalities, and both excessive thirst and appetite. Recently, Sara also feels dull and depressed, does not have much energy, and has stopped performing all her favourite activities including tennis at Action Indoor Sports Stadium. 

Sara is a successful and busy business person in Toowoomba, never smoked and only consumes alcohol in moderation at social events. She has several allergies (House dust mites, cockroaches, and dog's dander) and is not taking any medications other than a daily multivitamin tablet and betamethasone (as needed) for her asthma (used for many years). On clinical examination, the clinician, Dr John Smith noticed protuberant with striae and minimal bruising in her abdomen, and no abdominal tenderness, and both upper and lower extremities show areas of hyperpigmentation. Laboratory results confirmed that her cortisol levels were high indicating Cushing syndrome.

Answer only TWO questions

  1. Explain the causative factors and pathophysiology of Cushing syndrome and how she developed this condition. 
  2. Describe the primary signs and symptoms of Cushing syndrome.
  3. What aspects of her clinical history place Sara at increased risk of hypertension and, briefly explain the difference between Graves' disease and Cushing syndrome. 

4. What treatment and follow up options are there for her condition?

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FORMAT:

  1. Question number is mandatory in your answer; 
  2. You will be answering TWO of the four questions; 
  3. Each answer is worth of 250 words; + or — 10% allowable; 
  4. Font size 12; 
  5. Font Type: preferably Times New Roman or Arial; 
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7. Diagram and table will be allowed; but needing your explanation. 

Answer

Endocrine System

Question 1

Sara Haines, a 38-year-old woman, running a restaurant in at Toowoomba is diagnosed with Cushing syndrome after she complained of drastic weight gain for over six months, with menstrual abnormalities and significant facial hair growth. Cushing syndrome can be defined as a metabolic disorder, which is mainly caused by adrenal cortex overproducing corticosteroid hormones, often resulting in obesity and high blood pressure (Karageorgiadis et al., 2015). As explained by Lodish & Stratakis (2016), one of the most common causes of abnormally high levels of hormone cortisol is the high degree of usage of corticosteroid medications. The corticosteroids in the form of steroids and other anti-inflammatory drugs present in betamethasone, mainly help in reducing inflammation, swelling and production mucus in the airways of a person having asthma, are the primary causative factor, in this case, to cause high levels of cortisol for Mrs Haines.

Long-term exposure to excess levels of glucocorticoids can be used to describe Cushing syndrome, mainly caused by the excessive secretion of adrenocorticotropic hormone (ACTH) from a pituitary tumour, i.e. adenoma (Findling & Raff, 2017). The adrenal gland, stimulated by ACTH, secrets cortisol and other steroid hormones. Due to the stimulation by corticotrophin-releasing hormone (CRH) from the hypothalamus, pituitary gland produces ACTH to be released into petrosal venous sinuses in a diurnal pattern, which is independent of circulating cortisol levels. The release of CRH can also be stimulated by the neuronal input at the hypothalamic level, where the peak release occurs just before awakening, followed by the decline of ACTH levels throughout the day (Stratakis, 2016).


(Source: aafp.org)



Question 2

As discussed earlier, the exposure to high levels of hormone cortisol for a long time is the principal reason causing Cushing syndrome in the human body. The use of oral corticosteroid medication may have caused Cushing syndrome for Mrs Haines. Cushing syndrome, which is also known as hypercortisolism stimulates overproduction of cortisol, which creates some of the hallmark signs, such as a fatty hump between two shoulders, pink or purple stretch marks on the skin and a rounded face (Lacroix et al., 2015). The research of Lowe et al. (2017) confirmed that the particular disease also results in bone loss, high blood pressure, and type 2 diabetes in some situations. Depending on the levels of excessive cortisol, hence, the signs and symptoms of Cushing syndrome can vary from one person to another.

Nieman (2015) discussed that some of the common signs and symptoms include skin changes and progressive obesity, which principally evident in the case of Mrs Haines, who complained of drastic weight gains over the last six months. Hence, weight gain and fatty tissue deposits, particularly around the midsection and upper back alongside face and between the shoulders are the primary signs. Additionally, pink and purple stretch marks, i.e. striae on the abdomen, breasts, thighs and arms can be described as the main symptoms apart from thinning and fragile skin that easily captures bruises. Apart from reduced healing capacity and acne, women like Mrs Haines with such a syndrome experience irregular menstrual periods along with thicker facial hair and visible body (Bornstein et al., 2016). Muscle weakness and severe fatigue are some other signs of this disease.

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