Personal Narrative: Moving Away From God

Cushing ’s syndrome: Whole-Body Impairment Kim Gaull Rowan University 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

Cushing’s Syndrome 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,

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

Diagnostic Testing 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)

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

The patient presented with weight gain, flushed skin, tiredness, inability to concentrate, hirsutism, depression and facial swelling; which all indicate that the patient might be suffering from Cushings Syndrome.

Introduction Cushing’s syndrome is an endocrine disorder that is characterized by multiple signs and symptoms resulting

INTRODUCTION: Acute onset of refractory hypertension in an otherwise young, healthy patient should immediately raise suspicion for secondary (non-idiopathic) etiologies. This case represents a scenario of secondary hypertension due to Cushing’s syndrome stemming from an ectopic ACTH-producing bronchial carcinoid tumor in a young, active duty sailor. PATIENT PRESENTATION:

___ 2 Which two patients have hormone levels characteristic of Cushing’s syndrome? ___ Patients 2 and 5 have high levels of cortisol which is a characteristic of Cushing's syndrome.

Worker referred Rebecca for a random urine analysis on October 12, 2017 and November 06, 2017 at Caritas Family Solutions Office. Rebecca urine analyses were negative for all substances.

Brittanye is a 30yo, G1 P0, who was seen for a consultation due to her history of chronic HTN. She was on lisinopril and recently was switched to labetalol. She is on 100 mg q hs. She does have some issues with anxiety and is on Xanax and

Cushing’s syndrome results from chronic hypercortisolemia[5] of any cause, described by Cushing, in 1932, as a syndrome characterized by osteoporosis, amenorrhea[6], edema, purplish abdominal striae, obesity, fatigability and weakness, hypertension, glucosuria[7], basophilic tumor of pituitary and hirsutism[8].

Jennifer is a 31yo, primigravida, who is currently 33 weeks 6 days. She is followed in our perinatal diabetes program for GDM, which is currently controlled fairly well with metformin. She also has dichorionic twins that have been managed through your office. She had some decreased fetal movement yesterday and an ultrasound was requested today. She does report that she was seen in triage yesterday and those strips were fairly active but at one point her BP was mildly elevated and a p/c ratio was around .24. Since yesterday her movement has improved and is back to normal. Because she was being seen for diabetes we did schedule her for an ultrasound as well.

Sunday morning June 25, 2000, I went to church simply because I felt I should. I did not want to be there, but I had to go and fulfill my obligation. I stood at the beginning of praise, but after a few songs I sat down and placed

o Renal tests for impact of dehydration. As Ingrid is elderly I would be concerned that sustained emesis may result in impaired renal functioning with a risk of acute renal failure if not monitored and countered with intravenous fluids. o Full blood count. Miravalle (2015), states that a WBC count, erythrocyte sedimentation rate