1. Step 4; Hypothesis organization
1.1. Obesity
1.1.1. side effects
1.1.2. Over-eating
1.1.3. Depression
1.1.4. Tumor in the hypothalamus
1.1.5. ACTH-producing pituitary adenoma
1.1.6. Decreased activity
1.2. Death wishes
1.2.1. Alcohol
1.2.2. Asthma and Side effects of the medications
1.2.3. psychological issues; trauma
1.2.4. Poor school performance
1.3. DDX
1.3.1. Asthma and its treatment
1.3.1.1. Side effects
1.3.1.1.1. death wishes + obesity
1.3.1.2. Lifestyle of patients
1.3.2. Cushing's syndrome
1.3.2.1. Iatrogenic; side effects
1.3.2.2. ACTH-producing pituitary adenoma
1.3.2.3. Ectopic causes; lungs
1.3.2.4. tumor of the adrenal cortex
1.3.3. Hypothyroidism
1.3.4. Psychiatric
2. Step 5; Objectives
2.1. Histology and physiology of the adrenal gland (the hormones secreted and their regulation)
2.1.1. Glucocorticoid normal functions
2.2. Manifestations of hyper-cortisolism; glucocorticoid excess and causes
2.2.1. Measurement of cortisol
2.3. Relationship between glucocorticoids and mood
3. Step 1; identifying cues
3.1. 15 Y O girl
3.2. looking unhappy
3.3. Asthmatic and on meds
3.4. Gained weight
3.5. "wishes she could die"
4. Step 2; problem formulation
4.1. an asthmatic 15 year old girl, visiting her GP who noticed she had gained weight and seems to have death wishes
5. Step 3; hypothesis generation
5.1. Hypothyroidism
5.2. Side effects of the medications
5.2.1. steroids
5.2.1.1. Osteoprosis
5.2.1.2. Weight gain
5.2.1.3. Type 2 DM
5.2.1.4. Adrenal gland effects