The initial post must include responses to all the questions in both case studies.
Mrs. A has been taking high doses of glucocorticoids for much of the past 2 years to control severe rheumatoid arthritis. She has now developed hypertension and type 2 diabetes and would like to stop taking the cortisone because of the unwanted changes in her appearance.
- How does Cushing’s syndrome affect the individual?
- Discuss how hypertension and diabetes have developed and the potential complications of these conditions.
- Discuss other potential problems that Mrs. A may experience resulting from long-term use of glucocorticoids.
Mrs. L is a 63-year-old woman who reports constant back pain. Further inquiry into her medical history revealed that over the past 3 years, she has suffered fractures of her femur and wrist after minor falls. She experienced menopause at age 49. Mrs. L has a secretarial job, drives to work, and she “does not have time for exercise.” She reports that she consumes 8 to 10 cups of coffee a day and has been a smoker most of her adult life. She has not seen her physician recently nor had a recommended bone density test because of the time and cost involved.
- Relate Mrs. L’s history to the diagnosis of osteoporosis. What risk factors are present, and how does each predispose to decreased bone density?
- Explain the cause of pathological fractures in this patient.
- How could osteoporosis have been prevented in Mrs. L?
- Discuss the treatments available to the patient
Expert Solution Preview
Introduction: In this case study, two patients with different medical conditions are being discussed. Mrs. A has been taking high doses of glucocorticoids for the past two years to manage severe rheumatoid arthritis. On the other hand, Mrs. L has constant back pain and has suffered fractures in the past three years. The following questions need to be answered concerning these patients.
1. How does Cushing’s syndrome affect the individual?
Cushing’s syndrome is a condition that develops when the body is exposed to high levels of cortisol hormone for a prolonged duration. It affects the individual’s body in several ways, including weight gain, a rounded face, thin skin, and easy bruising. Other symptoms include muscle weakness, fatigue, high blood pressure, and high blood sugar levels. In severe cases, it can cause osteoporosis, depression, and cognitive dysfunction.
2. Discuss how hypertension and diabetes have developed and the potential complications of these conditions.
Mrs. A is taking glucocorticoids to manage her rheumatoid arthritis, which has led to her developing hypertension and type 2 diabetes. Glucocorticoids cause hypertension by increasing the levels of sodium in the body, leading to water retention and elevated blood pressure. They also increase insulin resistance, leading to type 2 diabetes. Complications of hypertension and diabetes include kidney damage, heart disease, and stroke.
3. Discuss other potential problems that Mrs. A may experience resulting from long-term use of glucocorticoids.
Apart from hypertension and diabetes, long-term use of glucocorticoids can also cause osteoporosis, which increases the risk of bone fractures. It can also lead to muscle weakness, thin skin, easy bruising, and slow wound healing. Glucocorticoids can suppress the immune system, making the individual more susceptible to infections.
4. Relate Mrs. L’s history to the diagnosis of osteoporosis. What risk factors are present, and how does each predispose to decreased bone density?
Mrs. L’s medical history of suffering fractures following minor falls and menopause at a younger age predispose to decreased bone density. Other risk factors for osteoporosis in Mrs. L include her sedentary lifestyle, smoking, and excessive caffeine consumption. Smoking and caffeine consumption lead to the loss of calcium from the bone, reducing bone density.
5. Explain the cause of pathological fractures in this patient.
Pathological fractures occur when the bone is weak and cannot withstand normal stress, leading to a fracture after minor trauma or even without apparent trauma. In Mrs. L’s case, pathological fractures are caused by osteoporosis, which leads to weaker bones that are prone to fractures.
6. How could osteoporosis have been prevented in Mrs. L?
Osteoporosis in Mrs. L could have been prevented by lifestyle changes such as regular exercise, stopping smoking, and reducing caffeine consumption. Adequate calcium and vitamin D intake could also have helped in preventing the disease. Bone density tests could have been done to detect osteoporosis early and intervene with treatment.
7. Discuss the treatments available to the patient
Treatment options for osteoporosis in Mrs. L include bisphosphonates, which reduce the risk of fractures, teriparatide, which stimulates bone formation, and hormone replacement therapy. Calcium and vitamin D supplements are commonly prescribed as they help in strengthening the bone. Lifestyle changes such as regular exercise, stopping smoking, and reducing caffeine consumption are also essential in preventing further bone loss.