Acute Onset Of Refractory Hypertension

Cushing’s syndrome is a rare endocrine disorder that occurs when your body is exposed to an overabundance of the hormone cortisol.3 Cortisol is known as the stress hormone. The interruption of cortisol secretion can cause weight gain and can ultimately determine where you put the weight on.8 There are many underlying causes such as Pituitary Adenomas, Ectopic ACTH Syndrome, Adrenal Tumors, and Familial Cushing’s Syndrome.2 The majority of these people affected by this hormonal disorder experience weak muscles, increase fat, high blood pressure, etc.1 Although thousands are affected in various ways, there are currently several channels of treatment administered by medical professionals. Through the use of improving technology, medical professionals are better understanding the disorder, allowing them to develop better treatment practices.

Cushing 's syndrome (CS) is characterized by pathologically elevated free glucocorticoid levels. Endogenous hypercortisolism is usually due to ACTH-secreting pituitary corticotropic adenomas and less often due to ectopic ACTH-secreting neuroendocrine neoplasms or ACTH-independent adrenal cortisol hypersecretion (Yaneva, 2010). Cushing 's disease occurs infrequently in an inherited setting in both of these conditions (Yaneva, 2010).

B.J. is a 54-year-old attorney who for several months has been experiencing generalized headaches that have responded poorly to nonnarcotic analgesics. He is also experiencing visual disturbances including blurred vision and double vision. On questioning, B.J. reports that he has gained 20 pounds over 2 years despite no change in activity or eating patterns. About his weight gain, B.J. jokes, “I guess it’s all in my feet. I had to buy new shoes, and my shoe size went from a size 10 to a size 12.” It was determined that B.J. should have a CT scan of his head to assess for a pituitary adenoma resulting in the

You graduated 3 months ago and are working with a home care agency. Included in your caseload is J.S., a 60-year-old man suffering from chronic obstructive pulmonary disease (COPD) related to (R/T) cigarette smoking. He has been on home oxygen, 2 L oxygen by nasal cannula (O2/NC), for several years. Approximately 10 months ago, he was started on chronic oral steroid therapy. Medications include ipratropium-albuterol (Combivent) inhaler, formoterol (Foradil) inhaler, dexamethasone (Decadron), digoxin, and furosemide (Lasix). On the way to J.S.’s home, you make a mental note to check him for signs and symptoms (S/S) of Cushing’s syndrome.

Smith came in with the same complaint as before, but is now stating he is also having shortness of breath. His vitals were taken and there was an additional concern. Mr. Smith's blood pressure was taken manually with a blood pressure cuff and stethoscope and determined his blood pressure was currently at 160/100 mmHg. The 160 or top number is the systolic blood pressure which is the amount of pressure being pushed through the arteries to the rest of the body while the heart is beating. The 100 or the bottom number is the diastolic blood pressure which is the amount of pressure in the arteries while the heart is at rest. The normal range for an adult is 120/80 mmHg. Mr. Smith had an MRI completed at it revealed metastasis of prostate cancer to osseous tissue. He also had an abdominal CT and it showed an obstruction of the intestine due to nodular enlargement of the adrenal glands. He was again admitted to the hospital and had additional labs ordered. He had to repeat the complete blood count and blood and urine potassium check, a blood glucose test, and an adrenal stress test to include serum aldosterone, 24 hour urinary aldosterone, renin, adrenocorticotopic hormone(ACTH) and cortisol

Another diagnostic method to diagnose adrenal tumors is cortisol saliva testing. In this test, the amount of cortisol in the saliva at or near midnight is normally very low. Multiple repeats of the test to confirm elevated cortisol levels can diagnose Cushing's syndrome. Cushing's syndrome is excess cortisol levels, possibly due to the body secreting too much

Elevated urine microalbumin/creatinine ratio. His last labs in January did show a mild increase. I will recheck that along with a basic metabolic panel and inform him of those results. A copy of them will be sent to Dr. Dourdoufis, as

Mr. S is a 29-year-old male with past medical history of (PMH) hypertension (HTN) and obesity who presented to local emergency room (ER) with headache and chest and back pain. Mr. s had been seen at urgent care three days prior for a headache and near syncope and was told to hold his metoprolol due to bradycardia. Due to health insurance related problem, he has been off amlodipine and lisinopril for a month.

1. Cushing's disease is a hormonal disorder which is caused by prolonged exposure of the body's tissues to high levels of the hormone cortisol. It is sometimes referred to as hypercortisolism, it is fairly rare and it most commonly affects adults between the ages of 20 to 50. There is an estimated 10 to 15 of every million people who are affected every year.

The basic cause for Equine Cushing's Disease is the lack of dopaminergic control within the intermediate lobe. As a result peptide hormones are overly secreted into the body. Melanotrophs of the intermediate lobe release pro-opiomelanocortin (POMC) into the body. This is then split to form three hormones: α-melanocyte–stimulating hormone (α-MSH), β-endorphin (β-END)–related peptides and corticotropin-like intermediate peptide (CLIP). Normally, dopamine binds to 2 inhibitory receptors on the melanotrophs, stoping the production of hormones. This function is lacking in individuals with Equine Cushing's Disease. Consequentially hypertrophy, hyperplasia, and over production of POMC peptides occur in the intermediate lobe of the pituitary gland.

5.Cushing's syndrome: a constellation of symptoms caused by steroid excess in the blood. The symptoms include humped back, muscle thinning and weakness, and lowered immunity.

Cushing’s Syndrome is a condition that results from chronic exposure to excessive amounts of glucocorticoids circulating in the blood stream for an extended period of time. The disease was first reported by Harvey Cushing over one hundred years ago, yet the condition still plagues endocrinologists today. Reasons for this difficulty include the vast amount of often vague symptoms that the syndrome presents, most of which are found in a plethora of other conditions as well, combined with the multiple forms that the condition can manifest itself. Symptoms of Cushings Syndrome include, but are not limited to, weight gain, hirutism, easy bruising, hypertension, acne, facial plethora, muscle weakness, striae, depression,

A female patient aged thirty-one years old was admitted to a surgical ward with a 48 hour history of emesis and abdominal pain in an unspecified quadrant. There was no account registered regarding the possible existence of headaches, blurred vision, loss of consciousness or change in bowel habit. Her arterial blood pressure was measured at 110/65 mmHG and her pulse 88 beats per minute and regular. A provisional diagnosis of intestinal obstruction was originally made, however upon later reviewing the patients background, it was ascertained that she had a history of both weight loss and anorexia, hyperpigmentation of the skin was also observed, which is more suggestive of a primary adrenal insufficiency. The patient was managed overnight with the intravenous administration of 1500 ml of 0.9 per cent saline, and by the following morn her manifestations had resolved.

Mrs. A (pseudonym) is an 83-year-old Samoan female of Christian religion who was admitted to an urban hospital on 02/04/15 by GP referral. She came in with chest pain associated with productive cough and shortness of breath (SOB) on exertion. She also complained of having recurrent episodes of vomiting mixed with saliva and fatigue. She has a history of asthma, hypertension, type 2 diabetes mellitus on Metformin and double incontinence due to a long-standing history of intermittent constipation. Her chest computed tomographic (CT) revealed right lower lobe opacity indicating pulmonary consolidation, which means that her right lower lung has accumulated exudates in the alveoli that would have normally been filled by gas, indicative of bacterial pneumonia. Furthermore, a sputum gram stain sample collected from Mrs. A showed gram-positive bacteria, which is also a characteristic of pneumonia. Her blood tests revealed a high haemoglobin count, which may be caused by an underlying lung disease, as well as high white blood cell count confirming the presence of infection. Considering all diagnostic results, Mrs. A was diagnosed with right lower lobe bacterial pneumonia.

Hypertension is defined a consistent elevation of the systolic blood pressure above 140mmHg, a diastolic pressure above 90mmHg or a report of taking antihypertensive medication. Early diagnosis and effective management of hypertension is essential because it is a major modifiable risk factor to cerebrovascular, cardiac, vascular, and renal diseases. The higher the blood pressure, the greater the risk for heart attack, heart failure, stroke, and kidney disease.