A 52-year-old man presents to his primary care physician for a yearly checkup complaining of recent weight gain. The patient states that he has noticed that, regardless of his diet, his midsection has gotten increasingly larger and his old clothes no longer fit. The patient has a 2-year history of left hip arthritis from a car accident for which he is on prednisone, as well as a history of migraine headaches. The patient has also noticed that in the last 2 months, he has developed acne and his face has become fuller in appearance. On exam, the patient has gained 26 pounds since his previous checkup 1 year prior, and he now has a BMI 28.2 kg/m^2 (up from 24.1 kg/m^2 previously). His temperature is 98.3°F (36.8°C), blood pressure is 134/94 mmHg, pulse is 72/min, and respirations are 12/min. His physical exam is notable for red striae on his shoulders and around his waist. On his labs, the patient’s serum ACTH is found to be decreased. Which of the following changes is most likely expected?
ABilateral adrenal hyperplasia
BLung malignancy
CUnilateral adrenal atrophy
DBilateral adrenal atrophy
EUnilateral adrenal hyperplasia
A 56-year-old woman visits her primary care provider complaining of fatigue, weight gain, increased thirst, hair loss, and headaches. She has been perimenopausal for 3 years. She was diagnosed with rheumatoid arthritis 4 years ago and prescribed oral prednisolone. Currently, she takes prednisolone and omeprazole daily. Her vital signs are as follows: blood pressure 150/90 mm Hg, heart rate 70/min, respiratory rate 13/min, and temperature 36.6°C (97.9°F). Her weight is 95 kg (209.4 lb), height is 165 cm (5 ft 4 in), BMI is 34.9 kg/m2, waist circumference is 109 cm (42.9 in), and hip circumference is 93 cm (36.6 in). At physical exam, the patient has abdominal obesity, round red face, and increased fat deposition on the back and around the neck. Her skin elasticity is diminished. Cardiac auscultation reveals fixed splitting of S2 with an increased aortic component. The rest of the exam is unremarkable. Blood analysis shows the following findings: Total serum cholesterol 204.9 mg/dL HDL 50.3 mg/dL LDL 131.4 mg/dL Triglycerides 235.9 mg/dL Fasting serum glucose 192.0 mg/dL Which of the following options describes the pathogenesis of the patient’s hyperglycemia?
AGlucocorticoids bind to surface receptors of the glomerular endothelial cells and inhibit filtration of glucose.
BGlucocorticoids activate surface membrane sodium channels in the islet beta-cells, which leads to Na+ influx and inhibition of insulin synthesis.
CBinding of glucocorticoids to surface G-protein-coupled corticosteroid receptors leads to activation of the inositol-3-phosphate pathway and consequent transcription of gluconeogenic enzymes.
DUpon activation of intracellular corticosteroid receptors in hepatocytes, its DNA-binding domain binds to glucocorticoid response elements and triggers transcription of gluconeogenic enzymes.
EExtensive gluconeogenic enzyme transcription is activated by glucocorticoids via the cAMP pathway.
An 8-year-old boy is brought to the pediatrician by his parents due to recurrent episodes of wheezing for the last 2 years. He uses a salbutamol inhaler for relief from wheezing, but his symptoms have recently worsened. He often coughs during the night, which awakens him from sleep almost every other day. He is not able to play football because he starts coughing after 10–15 minutes of play. His current physical examination is completely normal and auscultation of his chest does not reveal any abnormal breath sounds. His peak expiratory flow rate (PEFR) is 75% of expected for his age, gender, and height. After a complete diagnostic evaluation, the pediatrician prescribes a low-dose inhaled fluticasone daily for at least 3 months. He also mentions that the boy may require continuing inhaled corticosteroid (ICS) therapy for a few years if symptoms recur after discontinuation of ICS. However, the parents are concerned about the side effects of corticosteroids. Which of the following corticosteroid-related adverse effects is most likely?
ASuppression of hypothalamus-pituitary-adrenal (HPA) axis
BShort stature
CPosterior subcapsular cataract
DSteroid psychosis
EHoarseness of voice
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