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The Glucocorticoid Axis: Reem Alyahya
The Glucocorticoid Axis: Reem Alyahya
The Glucocorticoid Axis: Reem Alyahya
Reem Alyahya
Introduction
• A 46 y/o man present with fever, red
tender area on his right leg, consistent
with erysipelas.
• His recent medical history reveals
fatigue, easy bruising and wt. gain in the
past 6 months.
• His family history is negative for DM and
HT.
• physical examination shows central
obesity (BMI 32.5 kg/m2, waist
circumference 115 cm)
• BP 160/104
• Moon face appearance, a dorsal fat pad
in the neck and abdominal purple striae.
Learning objectives:
• Which additional radiological investigations do you recommend?
endogenous exogenous
Radiolabelled
Adrenal CT or
Pituitary MRI Chest X-ray octreotide
MRI
(Scintigraphy)
Adrenal CT or MRI:
Radiotherapy Surgery
Pharmacotherapy (Cushing’s syndrome)
• The goal of pharmacotherapy is to reduce morbidity and prevent
complications.
Trans-sphenoidal
removal of the
tumor.
Pituitary Bilateral
irradiation adrenalectomy
Trans-sphenoidal removal of the tumor
• The patient had moon face appearance, a dorsal fat pad in the neck and
abdominal purple striae.
• The diagnostic tests reveals that the patient has Cushing's syndrome.
• The patient will initially manage the cortisol levels by taking metyrapone
4 gm/ 3 daily, Ketoconazole, 200 mg /3 daily
• Further treatment decided based on the specific etiology.
• Kumar & Clarks, Clinical Medicine ,
eighth edition (2012).