A 45-year-old woman is presented with the following clinical criteria - Stomach

Question

A 45-year-old woman is presented with the following clinical criteria

- Stomach pains

- recent weight gain, and denies any diet changes/exercise changes

-has increased blood pressure

-she is currently obese and has stretch marks on her stomach

-the individual has peripheral edema and diabetes

you have come to the conclusion that this woman has crushing syndrome, a condition where an individual has high cortisol levels in the body.

identify 4 class of drugs that you would recommend that would help the individuals stomach pain.

Explanation / Answer

Cushing's syndrome is due to the hypersecretion of glucocorticoids,particullarly cortisol. It may be either due to pituitary origin or adrenal origin.

The patient has symptoms which denotes the disease.Lets have a look with the symptoms.Patient is edematous due to retention of salt and water. She gained weight due to fat accumulation.purple striae which is stretch marks on belly and is a common symptom for the disease occurs due to 3 reasons : 1. Stretching of abdominal wall by excess subcutaneous fat 2. Rupture of subdermal tissues due to stretching 3. Deficiency of collagen fibers due to protein depletion. Patient was diabetic as hyperglycemia can occur due to gluconeogenesis and inhibition of peripheral utilization of glucose. Hyperglycemia leads to glucosuria and adrenal diabetes. Retention of sodium and water results in increase in ECF(extracellular fluid) volume and blood volume leading to hypertension. All these symptoms and their explanations denote the disease in Cushing's Syndrome.

4 classes of drugs :

1. Inhibitors of steroidogenesis : suppress cortisol secretions. Examples are ketoconazole,metyrapone

2. Receptor agonists : Drugs that suppress adrenocorticotropic (ACTH) hormone secretion. Examples are somatostatin and vasopressin inhibitors.

3. Glucocorticoid receptor antagonists : Mifepristone is the example.

4. Pituitary directed treatment : Dopamine agonists : bromocriptine and cabergoline

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