Question

  

A 48-year-old woman presented to the Emergency Department with nausea, dizziness, and easy fatigability. She also complained of decreased appetite and unintentional weight loss of 16 kg over the last 10 months. Upon further examination pt. was also noted to have increasing darkening of the skin around the face and upper back. Pt. denied any headaches, blurry vision, loss of consciousness, and/or change in her bowel habits.

Pt. history includes Tuberculosis (when she was a child)

Surgical History: C-Section

Current reported medications: OTC Tylenol for muscle pain

Pt. denies smoking, drinking, and/or illicit drug use

Pt. denied use of any herbal and/or over the counter medications.

The physical examination revealed a middle-aged Caucasian women, pale, with generalized hyperpigmentation especially on the face, oral mucosa, between her knuckles and over the elbows. Heart and lung sounds were clear to auscultation. Neurological evaluation was normal. Skin was dry with decreased turgor. Bowel sounds were decreased but present. There was no significant peripheral lymphadenopathy. All other review of systems was within normal limits.

BP: 88/60, HR: 110, RR: 22, O2: 96% on RA, Afebrile

Laboratory work-up:

Blood sugar: 60

Na: 126

K: 6.0

WBC: 13.0

1. How is the above medication tapered? Why is it important to give this medication in the morning?

Answer 1

1. The above medication should be tapered slowly by reducing the dose on weekly basis before go off completely.