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Regulation of the Pituitary Gland by Dopamine
Published in Nira Ben-Jonathan, Dopamine, 2020
As illustrated in Figure 5.14, a patient with Cushing’s syndrome presents with multiple physical, medical, and mental changes. There is significant weight gain with uneven distribution of fat. The fat accumulates in the abdomen and torso, including the neck area, face, midline, and upper back, while the extremities are not affected, and may even become thinner. A round and red face, known as “moon face,” is a typical physical feature. Skin problems include acne, infections, easy bruising, and long healing periods after injury or bruise. High blood pressure, which can lead to serious and even life-threatening complications, is also common. Because cortisol plays an important role in the normal muscle functioning, fatigue and muscle weakness are prevalent. Decreased sexual interest and low libido also afflict patients suffering from Cushing’s syndrome. Male patients can have fertility problems and erectile dysfunction problems, while women may have imbalance of estrogen and progesterone and irregular menstrual periods. In addition, those suffering from this disease tend to have depression, anxiety and irritability.
Case 44: Unexplained Weight Gain
Published in Iqbal Khan, Medical Histories for the MRCP and Final MB, 2018
This lady has features strongly suggestive of Cushing’s syndrome. These include weight gain, which particularly affects the abdomen and face (‘moon face’), striae, hypertension, hirsuitism, menstrual irregularity and sweating. Other features that may be discovered include the typical ‘buffalo hump’, psychiatric disturbance, and insulin resistance. Causes of Cushing’s syndrome include the following:Cushing’s disease. Adrenal hyperplasia secondary to a pituitary tumour releasing an excess of ACTH.Exogenous corticosteroid administration. This is the commonest cause.Adrenal carcinoma.Ectopic ACTH production, e.g. due to small cell carcinoma of the lung, carcinoid syndrome.
Practice paper
Published in Andrew Schofield, Paul Schofield, The Complete SAQ Study Guide, 2019
Andrew Schofield, Paul Schofield
A 63-year-old lady with severe COPD cornes to see you in the GP practice, complaining of weight gain around her abdomen (despite no change to her diet) and feeling low in mood. For her COPD, she is taking salbutamol, ipratropium, oral steroids and home oxygen. On examination, you notice thinning of her skin and also a moon-face appearance. What is the syndrome called which explains her history and examination findings? What do you think the cause is in this lady’s case? (2)Name two other signs you might find on examination of this lady. (2)Another patient comes to see you with similar symptoms and examination findings as well as having a tanned appearance despite no excess sun exposure. However, this patient has no past medical history and no drug history.What is Cushing’s disease? (1)Suggest two initial investigations you would like to perform. (2)What imaging studies would you request for any Cushingoid patient? (2)How do you explain her tanned appearance? (1)
Romiplostim in adults with newly diagnosed or persistent immune thrombocytopenia
Published in Expert Review of Hematology, 2020
Maria L. Lozano, Bertrand Godeau, John Grainger, Axel Matzdorff, Francesco Rodeghiero, Jane Hippenmeyer, David J. Kuter
Across the guidelines, a short course of corticosteroids is recommended as first-line treatment [5,19,20,26]. Most patients respond to corticosteroids with a rise in platelet count, but improvements are usually transient and the majority of patients will relapse [5,26]. Although prolonged corticosteroid therapy may maintain a hemostatic platelet count in responding patients, it does not enhance the rate of remission [5,33] and long-term use is linked with a number of side effects that can be serious, distressing to the patient, and require close monitoring [5,19,20,26,34,35]. In a survey of ITP patients, 38% of the 542 respondents with current or past corticosteroid exposure reported stopping or reducing their dose due to side effects [34]. Weight gain or increased appetite (83% of patients), personality, mood or emotional changes (77%), and difficulty sleeping (75%) were the most commonly reported side effects. Another survey of corticosteroid-treated ITP patients and physicians (N = 64) showed that the most bothersome side effects related to changes in appearance: moon face, bloating or swelling (causing a ‘lot of bother’ in 43/63 respondents), and weight gain or increased appetite (‘lot of bother’ in 41/64 respondents) [35]. The next most bothersome side effects were emotional: insomnia, restlessness or trouble sleeping, anxiety or nervousness, and depression or stress. Other potentially serious adverse effects of corticosteroids may include hypertension, hyperglycemia, glucocorticoid-induced osteoporosis and glaucoma [36].
Cushings syndrome complicating pemphigoid gestationis
Published in Cogent Medicine, 2018
O.Y. Olisova, N.P. Tepljuk, A.R. Hubail, R.K. Belkharoeva, O.V. Grabovskaya, V.B. Pinegin
Treating BP with steroid may lead to a well-known side effect of steroid which is the development of exogenous Cushing’s syndrome (CS). The main presentation is with a rounded facial like structure “moon face”, central weight gain and subcutaneous fat in the upper neck and back “buffalo hump”, skin atrophy, easy bruising, striae, and hyperglycemia and muscle weakness. Patients are generally prone to infections and have a greater susceptibility to develop poor wound healing and atherosclerotic heart disease. CS is similarly associated with severe psychological adverse effects and has a great impact on the quality of life. Well known psychological conditions seen in such patients including anxiety, depression and psychosis (Lenung, 2015).
Pediatric Uveitis and Scleritis in a Multi-Ethnic Asian Population
Published in Ocular Immunology and Inflammation, 2021
Samanthila Waduthantri, Soon-Phaik Chee
Our results show that uveitis was more common than scleritis. Post U was the most common clinical manifestation. The majority of pan U and IU cases were bilateral, of insidious onset and persistent. In contrast, the majority of AU and PU cases were unilateral, sudden in onset and limited in duration. Most of the AU and IU were idiopathic. Most PU cases had infectious etiologies while most pan U cases had noninfectious etiologies. Overall, the prevalence of noninfectious uveitis was slightly higher (37.0%) than the infectious uveitis (33.3%) (Table 1). Among the noninfectious etiologies, sarcoidosis was the most common (14.8%) followed by HLA-B27 association (9.3%) and VKH (5.6%). All cases of sarcoidosis associated uveitis were presumed ocular sarcoidosis,31 as none of the patients underwent a biopsy to confirm the diagnosis. Among the infectious etiologies, Toxoplasma was the most common (7.4%) followed by HSV (5.6%) and dengue virus (5.6%). Uveitis associated with JIA (1.8%, n = 1) and malignancy (1.8%, n = 1) were rare. Among scleritis, PS was more common than AS. Most cases were idiopathic. The majority of the PS were persistent. Corticosteroids were the mainstay of SIT in both uveitis (72.2%) and scleritis (100%) patients. Mean duration of systemic corticosteroid therapy was 4.83 ± 2.42 months. Systemic corticosteroids were well tolerated except in 6 patients who developed cushingoid features such as moon face which resolved after discontinuation of treatment. Most cases responded well to SIT. Only 4 patients with uveitis and 1 patient with PS required biologics. Secondary ocular complications were noted in 74.1% of the uveitis cases and 63.2% of the scleritis cases. Nonetheless, the majority of patients with uveitis (68.5%) and all patients with scleritis had good visual outcomes.