1. 7.5 mg of predinsilone per day
2. Cushing's
2.1. Manifistations
2.1.1. Osteoprosis
2.1.1.1. Increased osteo-clast activity
2.1.2. Skin changes
2.1.2.1. Striae
2.1.2.2. acne
2.1.2.3. Hairsutism
2.1.2.4. Acanthosis Nigricans
2.1.3. Menstural abnormailities
2.1.4. Impotence
2.1.5. Mood changes
2.2. causes
2.2.1. Exogenus
2.2.1.1. Chronic use of steroids
2.2.1.1.1. Asthma
2.2.1.1.2. Rheumatoid artheritis
2.2.1.1.3. post-transplantation
2.2.1.2. Immune supression
2.2.2. Endogenous
2.2.2.1. Primary
2.2.2.1.1. in the adrenal gland itself
2.2.2.2. Secondry
2.2.2.2.1. 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
3.1.1.1. Not stored in vesicles
3.1.1.2. Smooth endoplasmic reticulum
3.1.1.3. 80% of the cholestrole needed for the formation of steroids is taken from LDL
3.1.2. 3 layers
3.1.2.1. Zona glumerolosa
3.1.2.1.1. Aldosterone
3.1.2.1.2. less lipid-containing cells
3.1.2.2. Zona fasiculata
3.1.2.2.1. Androgens and cortisol
3.1.2.3. Zona reticularis
3.1.2.3.1. Androgens and cortisol
3.1.2.3.2. 17 alpha-Hydroxylase
3.1.3. Cortisole is released in response to physical or psychological stress
3.2. Cortisole
3.2.1. Metabolic effects
3.2.1.1. fat
3.2.1.2. Carbohydrates
3.2.1.2.1. Insulin resistance
3.2.1.3. Protien catabolism
3.2.2. Stress
3.2.3. Immunity
3.2.3.1. 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
4.1.6.1. on oral steroids and inhalers + bronchodialtor
4.1.6.2. 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
4.1.9.1. mood changes
4.1.9.2. moved to a new house 4 years ago
4.1.9.3. alcohol and weed once
4.1.9.4. school performance is affected
4.1.9.5. Father is a smoker
4.1.9.6. No pets
4.1.9.7. father is verablly abusing her
4.2. Physical
4.2.1. Vitals
4.2.1.1. PR88
4.2.1.2. Weight; 83 Kgs
4.2.1.3. RR: 16
4.2.1.4. Un-productive coughh
4.2.1.5. No murmur on chest ausciltation
4.2.2. Tunner's scale
4.2.2.1. Breast is stage 4
4.2.2.2. Pubic hair is stage 5
4.2.3. General apperance
4.2.3.1. unhappy and non-communicating
4.2.3.2. Round face with acne. Hairsutism
4.2.3.3. Marked abdominal obesity; girth is 95
4.2.3.4. Striae
4.2.3.5. Reflexes are normal
4.2.3.6. No anemia or goiter
4.2.3.7. Wight above 97 centile
4.2.3.8. Height is lower than 3 centile