Personal Narrative: Moving Away From God

Healthcare maintenance. The patient has not had a physical in years. We will set her up to come back for this at next appointment. She is not had cholesterol done for quite some time. She does continue on TriCor for her hypertriglyceridemia. We will plan on doing blood work to include a vitamin D, CMP, magnesium, lipid panel, hemoglobin A1c, prior to her appointment in three months. She is seeing Christine Wasilewski, MD for her B12 deficiency and anemia. I will not therefore order test for

Afton is a 31yo, primigravida, who is currently 23 weeks 6 days. She has type 2 diabetes but her A1C coming into pregnancy was just under 6. A recent A1C in June was 6.1. She is currently on insulin with Levemir and NovoLog. She also has chronic HTN and takes labetalol. She is on a baby aspirin for preeclampsia prevention. She has been following in our perinatal diabetes program and we have made some adjustments. Because of her type 2 diabetes she is here today for a fetal ECHO.

There are many tell-tale signs a person will present that will not even have an endocrinologist question if he or she has Cushing’s syndrome. A predominant symptom of the disorder is a red, rounded face (also known as “moon face”). Another externally visual sign is excess weight gain, particularly in the abdominal region. The patient may not distribute fat properly and can have fat-loss in their extremities. These people typically take on the apple body type. Muscle, back, and bone pain are also common complaints (Nieman, 2015).

2. Due to the fact that not one single lab test is perfect, doctors will generally run a couple different kinds. The most common tests that are used to help diagnose Cushing's disease are the low-dose dexamethasone suppression test, measurement of midnight plasma cortisol or late-night salivary cortisol, and a 24-hour urinary free cortisol test. In some cases another test call the dexamethasone-corticotropin-releasing hormone test may be needed to help distinguish Cushing's disease from other causes of excess cortisol.

Jessica is a 29yo, G4 P1021, who was seen for an ultrasound evaluation and possible FTS. She overall denies any major medical disorders other than she does have some issues with depression but is currently not on treatment and states that she is doing okay currently. Obstetrically, she has one previous 36-week delivery in 2012. She was induced for what sounds like preeclampsia. She does not recall whether or not her BP was elevated but she had some liver dysfunction and some kidney dysfunction and the fetus was growth restricted at 3 lb 9 oz. It did stay in the NICU for about 30 days. However, again this was an induced preterm delivery and therefore she would not be a candidate for 17-OHP. Currently at this time she has no complaints.

Cushing’s disease is a disease of the endocrine system that is recognized by the overproduction of the pituitary gland which releases the hormone adrenocorticotropic hormone (ACTH) that in return leads to an overactive adrenal gland which produces a stress hormone called cortisol. The overproduction is caused by a tumor or additional growth at the base of the brain. This tumor is called an adenoma which is usually not a cancerous growth.

Jenelle still had questions and concerns. She wanted to make sure that Dr. Peter Weiss’ diagnostic findings were correct, so she consulted with her endocrinologist

Suspicion may initially result from the characteristic ‘cushingoid’ appearance in addition to a history of taking steroids. Levels of cortisol can be tested from saliva or a 24-hour urine collection. Levels of ACTH in the blood are also measured, along with potassium. Additional tests may be done to locate the cause, such as a tumor. (Williams, L., & Hopper, P., 2015)

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.

Cushings sydrome is characterised by a group of symptoms that occur as a result of elevated levels of cortisol.

Secondly, the confirmatory reagent used in the tests was expired but it was not reported to the demonstrators because she did not recognize it. Although the confirmatory reagent is only used for validating the test results and the use of the expired confirmatory reagent might not directly affect the test results, the test should be carried out at the optimal condition to obtain accurate test results. So the non-compliance would be classified as minor conditions as this does not directly affect the test result but is a requirement for approval1. Leah should report to the demonstrator if the confirmatory reagent was found to be expired before the test and check with the demonstrator if the reagent could still be used or needed to be replaced

The medical ethical committee of our medical centers approved the study protocol and all patients provided written informed consent before entering the study. All patients subjected to complete assessment including proper history, clinical examination, laboratory investigations (complete blood count, liver and renal function tests, blood sugar, and serum amylase), and imaging studies (ultrasonography and/or CT, MRCP).

I was in your office on March 15, 2016 for my Health & Wellness. I want to say first, thanks so much for finding the problem and the medication. I had back pain and I requested an X-ray to see where the pain is coming from, blood drawn to check my liver and potassium. I would like to know if you have received the results from the above tests. Also, I would like to know if there was a thyroid, prostrate, and cholesterol testing done? If so, may I have all the results if they are ready?

Even if levels are low one day, they may be high the next day in the same woman.

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,