WBR0273

Author	[[PageAuthor::Serge Korjian, M.D., Gonzalo A. Romero, M.D. [1] (Reviewed by Serge Korjian and Yazan Daaboul, M.D.)]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Physiology
Sub Category	SubCategory::Endocrine
Prompt	[[Prompt::A 53-year-old man presents to the clinic after noticing several bluish stretch marks on his abdomen. He has a history of autoimmune hepatitis treated with 20 mg daily 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 mmHg, heart rate is 86/min, and temperature is 36.6 ᵒC (98 ᵒF). On exam, the physician notices thick bluish striae on the abdomen and round, full facies with extra fat around the neck and upper 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 that results in increased circulating neutrophils and neutrophilia 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 circulating 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 that are collectively 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 prostaglandins, inhibition of histamine release, decrease in eosinophils and lymphocytes, 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. Educational Objective: Glucocorticoids cause an increase in anti-inflammatory cytokines such as IL-10 and TGF-β. References: Nakagawa M, Terashima T, D'yachkova Y, Bondy GP, Hogg JC, Van Eeden SF. Glucocorticoid-induced granulocytosis: contribution of marrow release and demargination of intravascular granulocytes. Circulation. 1998;98(21):2307-13. Hoes JN, Jacobs JW, Verstappen SM, Bijlsma JW, Van der heijden GJ. Adverse events of low- to medium-dose oral glucocorticoids in inflammatory diseases: a meta-analysis. Ann Rheum Dis. 2009;68(12):1833-8. First Aid 2014 page 332]]
Approved	Approved::Yes
Keyword	WBRKeyword::Glucocorticoids, WBRKeyword::Prednisone, WBRKeyword::IL-10, WBRKeyword::Cortisol, WBRKeyword::Cushing's syndrome, WBRKeyword::Steroids, WBRKeyword::Cytokines, WBRKeyword::IL-10
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::