A patient with arthritis is admitted to the hospital. The patient's serum glucose level is 350 gm/dL, and the blood pressure is 182/98 mm Hg. The nurse notes that the patient's face appears rounded and puffy. The patient complains of feeling weak. What will the nurse do?
a. Ask which drugs the patient takes for arthritis.
b. Contact the provider to discuss whether the patient has a pituitary carcinoma.
c. Request an order for ketoconazole [Nizor-al].
d. Suspect that this patient has Addison's disease.
A
Many patients with arthritis are treated with glucocorticoids. Because the doses necessary to suppress inflammation are larger than the physiologic doses used to treat adrenal insufficiency, patients can develop signs of cortisol excess with cushingoid symptoms. This patient has an ele-vated glucose level, hypertension, and the characteristic moon facies and muscle weakness of Cushing's syndrome; therefore, the nurse would be correct to ask about the medications the pa-tient takes for arthritis. A pituitary carcinoma could be the cause but is less likely. Ketoconazole is used after chemotherapy and radiation therapy in the treatment of a pituitary adenoma. This patient does not show signs of Addison's disease.
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