WBR0273
| Author | [[PageAuthor::Gonzalo A. Romero, M.D. [1] (Reviewed by Serge Korjian)]] |
|---|---|
| Exam Type | ExamType::USMLE Step 1 |
| Main Category | MainCategory::Immunology, MainCategory::Pathophysiology, MainCategory::Physiology |
| Sub Category | SubCategory::Endocrine |
| Prompt | [[Prompt::A 53 year-old man comes to the clinic after noticing several bluish stretch marks on his abdomen. He has a history of autoimmune hepatitis treated with daily 20 mg of prednisone for the past 8 months. He complains of weight gain and difficulty climbing stairs because his legs feel weak. His blood pressure is 150/72 mm Hg, heart rate is 86/min, and temperature is 36.6 ᵒC (98 ᵒF). On exam, you notice thick bluish striae on the abdomen, round, full facies, and extra fat around the neck and upper part of the back. Which of the following is correct about the hormone causing this patient’s syndrome?]] |
| Answer A | AnswerA::Promotes leukotrienes production |
| Answer A Explanation | AnswerAExp::Glucocorticoids cause a decrease in leukotriene production. |
| Answer B | AnswerB::Promotes leukocyte adhesion |
| Answer B Explanation | AnswerBExp::Glucocorticoids inhibit leukocyte adhesion, leading to increased circulating neutrophils accounting for the neutrophilia documented on blood examination. |
| Answer C | AnswerC::Increases IL-10 production |
| Answer C Explanation | AnswerCExp::Glucocorticoids cause an increase in anti-inflammatory cytokines such as IL-10 and TGF-β. |
| Answer D | AnswerD::Increases eosinophils |
| Answer D Explanation | AnswerDExp::Glucocorticoids cause a decrease in circulating eosinophils and decreases eosinophil production. |
| Answer E | AnswerE::Promotes neutropenia |
| Answer E Explanation | AnswerEExp::By inhibiting leukocyte adhesion, glucocorticoids causes an increase in circulating neutrophils leading to neutrophilia rather than neutropenia. |
| Right Answer | RightAnswer::C |
| Explanation | [[Explanation::Prednisone is a more potent formulation of the endogenous glucocorticoid cortisol. With chronic administration, patients develop characteristic changes associated with excess glucocorticoids known as Cushing's syndrome. Patients classically have symptoms of weight gain, abdominal obesity, and proximal muscle weakness. Physical exam reveals peripheral muscle atrophy, acanthosis nigricans, dorsocervical fat pad (buffalo hump), and purple abdominal skin striae. Patients are at increased risk for osteoporosis.
Glucocorticoids have several functions most important of which relates to suppression of the immune system. Glucocorticoids cause arrest of all pro-inflammatory pathways leading to a decrease in leukotrienes and prosaglandins, inhibition of histamine release, decrease in eosinophils and lymphocyes, and inhibition of leukocyte adhesion (cause for peripheral neutrophilia). Other functions include maintenance of blood pressure and increase in lipolysis and gluconeogenesis. Glucocorticoids also alter the production of cytokines causing a decrease in pro-inflammatory molecules such as IL-1, IL-2, IL-6 and an increase in anti-inflammatory or regulatory cytokines such as IL-10 and TGF-β. |
| Approved | Approved::Yes |
| Keyword | WBRKeyword::Glucocorticoids, WBRKeyword::prednisone, WBRKeyword::IL-10, WBRKeyword::Cortisol, WBRKeyword::Cushing's syndrome |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |