Discuss other potential problems that Mrs. A may experience resulting from long-term use of glucocorticoids.

1) 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.
2) 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.

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