Case
Fatima has noticed recent weight gain She states that she has always been in good shape and maintained her weight, but she has gained 15 pounds in the past 3 months. She tells you that she even feels too tired to exercise, something she did daily in the past.
It’s not only the weight gain that is bothering Fatima. She feels her body is “changing.” Her face has a more rounded appearance than when you saw her previously. Interscapular fat deposition is also apparent. Striae have appeared on her abdomen, breasts and arms. Fatima also complains of slower than normal wound healing. She reports more facial hair, and she feels as if her voice is deepening. At first, Fatima thought some of the changes may be due to menopause, because her menstrual periods were less frequent. Now, she is not so sure.
Vital signs and blood laboratory results reveal Fatima has elevated blood pressure, elevated serum glucose and cortisol. Cortisol levels are five times higher than normal. ACTH and CRF levels are undetectable.
Questions
Advanced Pharmacology questions:
6. What is the treatment for Fatima’s condition?
7. What is the initial medication therapy for Fatima and recommended dose?
8. Are there any other medications that could cause Fatima’s symptoms that you would want to be sure you were aware of?
Advanced Pathophysiology questions:
9.. If Fatima’s laboratory levels had revealed elevated cortisol and elevated ACTH, how would this have altered the diagnosis?
10. Describe the course of disease (signs, symptoms, physical exam, lab and diagnostic studies) that you expect if he remains untreated?
11. What is the difference between Cushing’s disease and Cushing’s syndrome and how would you evaluate both?
