Reference no: EM133850970

Ms. J.S., a 52 yo white female with two children (16 and 14 yo) presents with history of fatigue, weight gain and muscle weakness over past two years. She initially thought it was caused by work stress and busy family life but has also noticed that she bruises more easily than in the past. She also noted purple lines (stretch marks) that you identified as striae (Links to an external site.). All of the above symptoms have been getting worse. Blood pressure is 170/110, respirations 12/min and some ankle edema (non-pitting) was noted. The limbs seem relatively thin and the trunk thickened, especially between the upper shoulder blades. Diagnosis was made of Cushing's disease/syndrome. How could you differentiate between the two? Elevated levels of cortisol has two effects of plasma leading to increased volume: 1) up-regulation of receptors for aldosterone and 2) an increased effectiveness of ADH (either by centrally increasing ADH release or peripherally by increasing the cellular responsiveness).

Question

1 What effects would these two changes (increased responsiveness to aldosterone and ADH) have on Na+, K+ and water levels in the plasma?

2 Where does cortisol secretion occur, and thus is a potential site of an over-secreting tumor? How else could someone develop Cushing syndrome if not by a tumor in that area?

3.  Which of the following influences the secretion of ACTH?

1. Cortisol levels in the plasma

2. Corticotropin releasing hormone from the hypothalamus

3. Neuro-endocrine reflexes

4.  All of the above

4. What is the most common cause of Cushing syndrome in the United States?

1. Adrenal tumors

2. Infections

3. Pituitary tumors

4.  Glucocorticoids prescribed by healthcare work