Patient Diagnosis
The patient has Cushing’s Syndrome; this is evidenced by some of the symptoms she is having concurrent with those of Cushing’s syndrome. Being 35 years of age, the patient falls between the 30-50 age group of prevalence, which is a disposition factor. Cushing syndrome results in hypercortisolism, which is responsible for most symptoms. The patient was observed having significant facial hair growth uncommon in women and a condition called Hirsutism, a symptom of crushing’s syndrome. The dull headaches Mrs. Boudreaux is experiencing are due to hypertension caused by the high cortisol levels, which is also responsible for the menstrual disturbances. Excessive thirst and appetite indicate that the patient had hyperglycemia due to polyphagia caused by the excess cortisol levels and polydipsia and promoted by fat deposition, let to her truncal obesity and full round face. Skin hyperpigmentation is present in the patients, common with ACTH-dependent hypercortisolism patients. Mrs. Boudreaux’s also presented muscular atrophy with minimal bruising on her hands and arms consistent with increased protein metabolism, which is an effect of overproduction of cortisol. The muscle atrophy could be why she has been fatigued lately and unable to carry out her usual engaging activities. Neural function depression, an effect of the crushing syndrome, could also be the reason behind her mood changes, such as her feeling depressed and her alert but anxious mood. The fact that she has a protuberant abdomen with striae is also direct evidence of her having fat deposits and muscle wasting resulting in the two symptoms (Innes 2020)
Imaging Techniques
A CT scan or MRI would be most convenient in establishing the specific cause of diagnosis because they detect most adrenal adenomas. The pituitary adenomas being non-cancerous growths on the pituitary glands may cause excessive production of cortisol- a responsibility of the pituitary gland and thus resulting in Cushing’s Syndrome. Pituitary tumors make the larger percentage of causes of hypercortisolism that is not caused by glucocorticoid medicine. The imaging studies should, however, be performed after having done the biological evaluation to ensure the biological abnormalities coincide with the anatomic ones (Syndrome & Health, 2022)
Treatment Of Choice
Treatment of choice for the diagnosis is dependent on the cause of the disease having in mind the disease has a 50% five-year mortality rate. Biosynthesis of corticosteroids is inhibitable using ketoconazole or metyrapone. The best treatment would be the surgical removal of the pituitary tumor followed by a hydrocortisone replacement therapy that lasts from 6-36 months until the recovery of the ACTH secretory functionality. laparoscopic removal or loin incision can be done to remove adrenal adenomas. Mitotane, an analytic drug, is given for cases where the tumor bed has been irradiated and the adrenal carcinoma resected (Innes, 2020).
Gamma knife radiation is an alternative treatment that normalizes cortisol levels and is only effective in a quarter of patients. However, it’s the best option for poor surgical candidates through pharmacological approaches that may be attempted in such a case. In the pharmacologic approach, ketoconazole is used to suppress cortisol synthesis. However, hypertoxicity levels of the liver have to be observed. In contrast, administration of Metyrapone in the inhibition of cortisol synthesis may be used, but it results in masculinity effects in females. A third of the cases have also reported suppressed ACTH secretion due to administering somatostatin both adrenal glands may be laparoscopically removed in cases where the tumors are irresectable (Syndrome & Health, 2022)
Type Of Menstrual Abnormality
Since the Cushing’s syndrome disease is more common in women than men, it mainly presents with symptoms like menstrual disturbances. Excessive bleeding during menstruation may be abnormalities caused by elevated blood pressure and blood vessel wall wasting due to increased protein metabolism caused by the excess cortisol. The increased appetite and fat deposition may affect the ovulation cycle resulting in the delayed or early onset of menstruation. Hypercorticortisol also results in inhibition of both inflammatory and immune responses of the body during menstruation, and the lady may develop complications and infections due to reduced immunity. The excess fat deposit also affects the gametogenesis functionality of the ovaries. The fat deposits on the lower abdomen may apply pressure on the uterine blind vessels, affecting the blood flow to the uterus and other parts of the female reproductive system (Innes, 2020).
Cause Of Headache
Adrenal gland tumors are one of the main causative effects of the crushing’s syndrome. The adrenal tumors increase the patient’s cerebral pressure, resulting in headaches as the blood vessels are pressed against b the tumor. Hypercortisolism leads to increased blood pressure caused by the sensitization of α-adrenergic receptors found on the arterioles’ smooth muscle cells and enhancing circulating catecholamines` vasoconstrictive effects. The increased pressure causes strain on the cranial blood vessels, which have already experienced protein wasting and probable constriction due to fat deposition and thus resulting in increased cranial pressure causing headaches in the patient (Chaudhry & Singh 2021).
References
Syndrome, C., & Health, N. (2022). Cushing’s Syndrome | NIDDK. Retrieved 18 February 2022, from https://www.niddk.nih.gov/health-information/endocrine-diseases/cushings-syndrome#:~:text=Cushing’s%20syndrome%20is%20a%20disorder,glucose%2C%20also%20called%20blood%20sugar
Innes, J. A. (2020). Davidson’s Essentials of Medicine E-Book. Elsevier Health Sciences.
Chaudhry, H. S., & Singh, G. (2021). Cushing syndrome. StatPearls [Internet].
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