Unhappy and Unwell

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Unhappy and Unwell by Mind Map: Unhappy and Unwell

1. 7.5 mg of predinsilone per day

2. Cushing's

2.1. Manifistations

2.1.1. Osteoprosis Increased osteo-clast activity

2.1.2. Skin changes Striae acne Hairsutism Acanthosis Nigricans

2.1.3. Menstural abnormailities

2.1.4. Impotence

2.1.5. Mood changes

2.2. causes

2.2.1. Exogenus Chronic use of steroids Asthma Rheumatoid artheritis post-transplantation Immune supression

2.2.2. Endogenous Primary in the adrenal gland itself Secondry in the hypothalamus or the anterior pituitary

2.3. Pseudo-Cushing's

2.3.1. Alcholism

2.3.2. Contraceptive pills

2.4. Measurment of Cortisol

2.4.1. Dexamethasone-supression test

2.4.2. 24-hour urine analysis

3. Step [6] Review of Previous Session

3.1. Histology

3.1.1. Steroids Not stored in vesicles Smooth endoplasmic reticulum 80% of the cholestrole needed for the formation of steroids is taken from LDL

3.1.2. 3 layers Zona glumerolosa Aldosterone less lipid-containing cells Zona fasiculata Androgens and cortisol Zona reticularis Androgens and cortisol 17 alpha-Hydroxylase

3.1.3. Cortisole is released in response to physical or psychological stress

3.2. Cortisole

3.2.1. Metabolic effects fat Carbohydrates Insulin resistance Protien catabolism

3.2.2. Stress

3.2.3. Immunity Mlocks the production of IL-2, Leukotreins, and histamine release from mass cells

3.2.4. Skin effects; maintaing structure through collagen and fibroblasts

4. Step [7]: Inquiry Plan & Information Gathering

4.1. History

4.1.1. Onset: 6 months ago of 12 Kgs

4.1.2. Depressed

4.1.3. 4 hospital-admissions over 6 months

4.1.4. Loss of school-time

4.1.5. Got aggressive with the hospital staff

4.1.6. Past on oral steroids and inhalers + bronchodialtor Mennarache started at 14, with one being dysmennorhea and skipping one as well

4.1.7. Striae in her abdomen,axilla and inner thighs

4.1.8. at age 11, she gained weight and her face got rounder

4.1.9. Social and family mood changes moved to a new house 4 years ago alcohol and weed once school performance is affected Father is a smoker No pets father is verablly abusing her

4.2. Physical

4.2.1. Vitals PR88 Weight; 83 Kgs RR: 16 Un-productive coughh No murmur on chest ausciltation

4.2.2. Tunner's scale Breast is stage 4 Pubic hair is stage 5

4.2.3. General apperance unhappy and non-communicating Round face with acne. Hairsutism Marked abdominal obesity; girth is 95 Striae Reflexes are normal No anemia or goiter Wight above 97 centile Height is lower than 3 centile

4.3. Investigations

5. Step [8]: Diagnostic Decision

5.1. Cushing's Syndrome and depression

6. Learning Objectives

6.1. Short and long term managment of Cushing's, depression and weight gain