A 30-year-old woman presents with depression, insomnia, & recent-onset growth of

Question

A 30-year-old woman presents with depression, insomnia, & recent-onset growth of body hair. She has a ruddy complexion. She had an episode of depression & acute psychosis following an uncomplicated delivery of a normal baby boy 9 months previously. Her heart rate was 90 BPM, & her blood pressure was 146/110 mm Hg. White blood cell count, hemoglobin, & hematocrit were within normal limits.

Pituitary, thyroid, & adrenal function were evaluated:
Patient’s Values Normal Values
TSH (S) 3.2 ug/ml 0.7 - 7.0
T3, Total (S) 160 ng/dl 75 - 200
T4, Total (S) 6.2 µg/dl 4.6 - 12
Prolactin (S) 14 ng/ml Nonpreg. <20
LH (S) 6 mg/ml 5 - 20
FSH (S) 10 mg/ml 2.6 - 16
ACTH, 08:00 (P) 135 pg/ml <100
Cortisol (24 hr urine) 160 ug 20 - 90
17-OH-Corticosteroids (24 hr urine) 11.9 mg 3 - 8
17-Ketosteroids (24 hr urine) 18.8 mg 5 - 15






What is your diagnosis? Provide evidence (signs and symptoms) to support your answer completely.



How might this patient be treated?

Explanation / Answer

Its cushings syndrome look at the link http://www.medcastle.com/case-study-no-4-in-endocrine-disorders.html reatment depends on the cause. Cushing syndrome caused by corticosteroid use: Slowly decrease the drug dose (if possible) under medical supervision. If you cannot stop taking the medication because of disease, your high blood sugar, high cholesterol levels, and bone thinning or osteoporosis should be closely monitored. Cushing syndrome caused by a pituitary tumor or tumor that releases ACTH: Surgery to remove the tumor Radiation after removal of a pituitary tumor (in some cases) You may need hydrocortisone (cortisol) replacement therapy after surgery, and possibly continued throughout your life Cushing syndrome due to an adrenal tumor or other tumors: Surgery to remove the tumor If the tumor cannot be removed, medications to help block the release of cortisol

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