How is the medication Mr. Clark is taking for asthma tied into the onset of Cushing’s syndrome? Is the use of topical cortisone cream clinically significant to his diagnosis? How might patient teaching reinforce the physician’s treatment plan?
Thirty-six-year-old Mr. Clark keeps his appointment for a physical examination. He presents with subtle symptoms of fatigue and concern about his weight gain of 14 pounds in the last year. Friends and family have told him that his color looks “funny” (bronze-tinted) and have noticed that his face and hands look puffy. He admits to feeling depressed and is worried about missing too much work over the past several months because of “being sick a lot.” He states that he has less interest in having marital relations with his wife.
According to Mr. Clark’s history he is a fragile asthmatic since adolescence and takes lots of medication to control his asthma, including prednisone and a steroid inhaler. Upon physical examination Mr. Clark exhibits the following: moderate muscle weakness, noticeable weight gain, particularly around the abdominal area which is striated. Fat pads are noted in the posterior neck and back (known as buffalo humps). His face is abnormally rounded, a condition known as moon facies. His blood pressure is elevated to 158/92. Mr. Clark requests a refill of his prescription strength cortisone ointment for flea bites that appear on his legs and trunk, probably associated with his two dogs.
Laboratory tests confirm the doctor’s suspicions. The 24-hour urine free cortisol concentration is increased. No evidence of other causes for his symptoms is uncovered—that is, no tumors or lesions are found in the structures of the endocrine system. After testing is complete, the diagnosis is Cushing’s syndrome and the cause is considered iatrogenic: Medication taken for Mr. Clark’s chronic asthma induced the disease.
- How is the medication Mr. Clark is taking for asthma tied into the onset of Cushing’s syndrome? Is the use of topical cortisone cream clinically significant to his diagnosis?
- How might patient teaching reinforce the physician’s treatment plan?
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