1. Step 1; identifying cues
1.1. 15 Y O girl
1.2. looking unhappy
1.3. Asthmatic and on meds
1.4. Gained weight
1.5. "wishes she could die"
2. Step 2; problem formulation
2.1. an asthmatic 15 year old girl, visiting her GP who noticed she had gained weight and seems to have death wishes
3. Step 3; hypothesis generation
3.1. Hypothyroidism
3.2. Side effects of the medications
3.2.1. steroids
3.2.1.1. Osteoprosis
3.2.1.2. Weight gain
3.2.1.3. Type 2 DM
3.2.1.4. Adrenal gland effects
3.3. Depression due to obesity
3.4. glucocorticoid excess
3.5. High cortisol levels
3.6. Pituitary tumor
3.7. Adrenal gland tumor
4. Step 4; Hypothesis organization
4.1. Obesity
4.1.1. side effects
4.1.2. Over-eating
4.1.3. Depression
4.1.4. Tumor in the hypothalamus
4.1.5. ACTH-producing pituitary adenoma
4.1.6. Decreased activity
4.2. Death wishes
4.2.1. Alcohol
4.2.2. Asthma and Side effects of the medications
4.2.3. psychological issues; trauma
4.2.4. Poor school performance
4.3. DDX
4.3.1. Asthma and its treatment
4.3.1.1. Side effects
4.3.1.1.1. death wishes + obesity
4.3.1.2. Lifestyle of patients
4.3.2. Cushing's syndrome
4.3.2.1. Iatrogenic; side effects
4.3.2.2. ACTH-producing pituitary adenoma
4.3.2.3. Ectopic causes; lungs
4.3.2.4. tumor of the adrenal cortex
4.3.3. Hypothyroidism
4.3.4. Psychiatric
5. Step 5; Objectives
5.1. Histology and physiology of the adrenal gland (the hormones secreted and their regulation)
5.1.1. Glucocorticoid normal functions
5.2. Manifestations of hyper-cortisolism; glucocorticoid excess and causes
5.2.1. Measurement of cortisol