Enron Scandal


Question # 1:

 The culture within Enron was that of corruption greed and deception. The top executives did not sustain an open relationship with the employees and other stakeholders of the firm. The culture was therefore the driving force that led them to hide the company losses and paint the wrong profitability picture to the other people. The leadership under Jeff Skilling and Kenneth Lay were more about enriching themselves than listening to the demands of their juniors. However, they were not the only people who contributed to this culture. The supply chain members were also players in the same game. In any firm that thrives on a proper supply chain, any problem affecting the firms displays itself in this supply chain as a reflex (Fontana). The areas that feel the impact of any survival squeeze are the logistics, quality control, overtime labor, safety stocks, suppliers’ quality, and external spending. Therefore the supply chain partners will notice the changes in stock, lagging in response times, late deliveries, partial order fills, and general improper communication.

The culture of greed engulfed even the members of the supply chain when the top management would fire or dismiss any employee or supply chain member if they raised any questions. Eventually, they eliminated all those who were not on their side and thus maintained the greed culture. Many of the supply chain partners were well to do people and did not want to lose their contracts with the company.  The lying and deception continued up to these levels and they did not report any form of malpractice. Therefore they kept lying to the outsiders to keep their sticks while they sold their own.

If the supply chain partners were vigilant and report the case early, then the system would have survived. The regulators or supply chain partners could have reported the performance changes, suspend any collaborator status, and take corrective actions (Fontana). The partners would have taken a site visit on the company and be on the lookout for a change in personnel, performance metrics, empty workstations, and crew strength. This way they could find a proper corrective action after analyzing the problem.




Question 2

President Bush and his family had a long-standing relationship with Kenneth Lay who was a top executive at Enron. Ken Lay was a supporter of Bush in his 1994 run for Texas Governor where he continued $37,500 to the campaign ( Richard, and Don). The company went on to be a generous donor to the Bush campaign and in turn, Bush advocated for the issues dear to Enron such as deregulating electricity markets and restricting large civil jury awards. Mr. Lay also was close with Bush’s vice President, Cheney who also directed important energy policies (Jr, Richard, and Don). The long-standing and public relationship between the two thus created a positive impression for Mr. Lay within the company. The employees and the general public thus saw him in a positive light and were not aware of the existence of greed and deception in his workings. This is one of the many ways that he created a positive image within the public that created reassurances without proving the profitability of Enron’s endeavors.

The most prominent tactic used by Enron management to hide their tendencies appeared in their accounting platforms. Skilling introduced the Market-to-Market accounting method which measures the fair value of accounts that can change over time. The method however can be manipulated, since it is not based on the actual cost but fair cost. The company thus logged in the estimated profits instead of the real profits. The company also used the tactic of trading everything. Their success in the energy trade gave them the hubris to invest in many more subsidiaries such as blockbuster, Enron Online, and SPVs (Li 37). The failures started mounting from the subsidiaries and they used the accounting tactics to cover it up.  Enron invented the partner companies to hide the n losses leaving the stock markets looking good. Scrutiny into these tactics brought them down.

Work Cited

Fontana, John. “The Supply Chain: A Canary in the Corporate Coal Mine – Inbound Logistics.” Www.Inboundlogistics.Com, 1 Oct. 2002, www.inboundlogistics.com/cms/article/the-supply-chain-a-canary-in-the-corporate-coal-mine/. Accessed 17 June 2020.

Jr, Richard A. Oppel, and Don van Natta Jr. “ENRON’S COLLAPSE: THE RELATIONSHIPS; Bush and Democrats Disputing Ties to Enron.” The New York Times, 12 Jan. 2002, www.nytimes.com/2002/01/12/business/enron-s-collapse-the-relationships-bush-and-democrats-disputing-ties-to-enron.html. Accessed 17 June 2020.

Li, Yuhao. “The case analysis of the scandal of Enron.” International Journal of business and management 5.10 (2010): 37.

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Jeff Skilling and Kenneth Lay Bush Family

Question # 1: The corporate culture nurtured by Jeff Skilling and Kenneth Lay manifested itself in driving the organizational behavior that became the accepted ?norm? at Enron. Discuss how the supply chain may have indirectly influenced those behaviors and if there was anything within the supply chain that regulators could have done to prevent the collapse of Enron.

Question # 2: Explain how the perception of Enron employees and the general public may have been affected based on the relationship between Ken lay and the ?Bush Family?. What are some of the operational and strategic tactics, perhaps embedded within their Business Plan  used at Enron to create ethical support and the pro-Enron attitudes that were prevalent.

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Nenets Community











Nenets Community

The Nenets is a group of hardy pastoralists who reside in the Russian arctic. They are a one of a kind remote community that is known for their reindeer herding. The community consists of a group of around 50,000 people who manage to move 300,000 reindeers over a 1,100km stretch from summer pastures in the north to winter ones in the south of the arctic. Living in an environment where temperatures go as low as -500 and their difficult kind of herding produces a community that has a unified work ethic and a vibrant culture. What is even more impressive about their culture is that it has survived history through the Russian colonization, Stalin’s regime, and modern-day oil and gas development and globalization.

Demography and Location

The community is of Samoyedic ethnicity that is native to the Russian arctic north and the Yamal Peninsula of Siberian arctic.  The 2010 census revealed that their population is 44,857 within Russia (Taylor, 2012). They occupy the region that stretches from the Arctic Ocean to the arctic circle between Taymyr and Kola peninsulas. The major languages are Tundra and Forest Nenets. The majority of the population is of an older generation.

Culture and Economy

The economy of the Nenets is heavily dependent on pastoralism of reindeers. The community has almost 10,000 herders organized into groups known as Brigady (Taylor, 2012). The groups graze south in the Tundra forest in winter, migrate during spring to the north and spend a short summer and repeat the same at the end of the summer. The reindeers provide the community with food, clothing, shelter transport, spiritual fulfillment, and means of socializing (Stammler-Gossmann, 2010). The people gain money and supplies mainly through selling reindeer meat. They also sell reindeer antlers to china that is made to a male potency drug. The people also supplement their life through hunting and fishing which they sell the outcomes for money and supplies.

The religion practiced in the community is Shamanism. They also have an animistic belief system that reveres land its resources (Taylor, 2012). They migrate with a holy sleigh that carries with it bear skins, coins, and religious figures and are unpacked during religious rituals. The government of the community is held by the community elders who guide the group’s travels, lead religious rituals, and settle disputes among the people. The people have a world view known as Sya mei. It is a force that connects their world and one before birth and after death.

Way of Life

The stable food is the reindeer’s meat supplemented by fish and game meat. The transport system in the region also involves of sledges pulled by the reindeers. The people dress in traditional clothing made by women. A Nenet man wears a Malitsa, which is a coat made from four reindeer skins; the fur is in the inside close the body while the leather is on the outside; it is accompanied by a hood and gloves. The women wear a Yagushka created by 8 reindeer skins and buttoned at the front (Taylor, 2012). Both genders wear hip-high boots made of reindeer leather and tied up with a belt.

Their houses are known as Chum and are made of reindeer skins laid over wooden poles. One family occupies a Chum and they move with the house during their migrations. The community defines labor according to gender. The males are tasked with herding, slaughtering the animals, and choosing places for settlement and pastures. The women, on the other hand, do much of the domestic functions such as cooking, making clothes, and looking after the children. The children perform gender-based roles and are trained by their parents; however, the introduction of schools has presented an alternate life (Stammler-Gossmann, 2010).

Effects of Globalization to the Nenets

Globalization defines the interdependence or world culture, economies, and populations brought about by trade, technology, and information flow. The Nenets have not been left out of the effects of globalization. The discovery of oil and gas in the Nenet region has increased their contact with the outside world (Stammler-Gossmann, 2010). The oil industry has decreased the grazing lands and affected their traditional kind of life. They are now assimilating to modern social and political culture. Globalization has brought widespread education into the Nenet population and many of them are growing out of the culture to be successful professionals. Members of the community are also shifting to modern cities but find a hard time adapting to those environments (Stammler-Gossmann, 2010).




Stammler-Gossmann, A. (2010). ‘Translating’ Vulnerability at the Community Level: Case Study From the Russian North. Community adaptation and vulnerability in Arctic regions (pp. 131-162). Springer, Dordrecht.

Taylor, A. (2012, April 11). The Nenets of Siberia. The Atlantic; The Atlantic. https://www.theatlantic.com/photo/2012/04/the-Nenets-of-siberia/100277/

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Research a remote/isolated culture somewhere in the world.

Research a remote/isolated culture somewhere in the world.

Answer some key characteristics of this culture in your paper.

1) Where are they located on earth?
2) What does their worldview, religion, government, and economy look like?
3) How do they dress, what do they eat, how do they raise their children?
4) How has globalization and technology affected this group? What challenges do they face? (be sure to define globalization in your paper.)

Your essay should be 2-3  pages, in APA format summarizing your research. While all parts of your essay require you to respond in your own words, it is important to substantiate your argument with at least 2 academic sources, with one reference from your E-text.  These sources should include academic articles from the Berkeley library

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The relevance of Heart of Darkness Joseph Conrad to the World Today

The relevance of Heart of Darkness Joseph Conrad to the World Today

Heart of darkness by Joseph Conrad was published in 1899 in a popular Blackwood’s Magazine. The initial readers of the story couldn’t have foreseen the fierce debates the book would present even within the modern-day. The story has been used several times throughout history in movies, poems, and novels because of its compelling indulgence in problems that face humanity. The story is a chilling fictional account of the imperial period of colonial domination within Congo. At this time, Europe had entranced into the realm of possibilities of their discovered colonies, and the African consistent was seen as an antithesis of the European industrialism. The heart of darkness is relevant to today’s times because it has elements of sexism, racial inequality, and capitalist inequality, which are the same issues that society is still struggling within 2020.

Capitalist Inequality

Elements of the British company capitalism are vivid within the book, as explained by Conrad. The Belgian colonizers took the trip to Africa in what was seen as an effort to bring civilization to the savages within the region. Their real intention was hidden; they wanted to exploit the land in the Congo region.  The Belgian trading company in Congo sent agents all over the different regions, and they found out that there was an abundance of Ivory within the region, which was useless for the locals.  The workers and the managers gained greed for this wealth and acted out madly. They did whatever they could do to get a hold of this Ivory to bring them more money. The Ivory came at the cost of harming and killing a few people and destroying several hectares of land. Conrad writes,

“The word ‘ivory’ rang in the air, was whispered, was sighed. You would think they were praying to it. A taint of imbecile rapacity blew through it all, like a whiff from some corpse. By Jove! I’ve never seen anything so unreal in my life. And outside, the silent wilderness surrounding this cleared speck on the earth struck me as something great and invincible, like evil or truth, waiting patiently for the passing away of this fantastic invasion.” (Joseph Conrad, page.12)

Ivory was on everyone’s mind within the Congo region from the manager, the brickmaker, and even Mr. Kurtz.  Mr. Kurtz is obsessed with obtaining it, and the fact that he got it more than any other agent within the region brought fame to him.  The Ivory in this book, therefore, is used to signify the greed and capitalistic mindset of the European. It was the reason that the ones who collected the more Ivory were given promotions and higher ranks. Eventually, they forgot about their main mission there and focused on the trade of Ivory.

Capitalistic exploitation is present even in the market today.  Firms like Nike and GAP Inc. have displayed exploitation through child labor, and lower wages in their workers in developing nations. The same is not replicated in the developed countries, which is their market.  Humans are trafficked for cheap labor in different markets today. For example, there was a trend of exploitation in Myanmar, where potential employees were recruited in poor countries for high paying jobs. They were later scammed, their passport confiscated, and forced into signing contracts and later trafficked to Myanmar to produce Nike shoes at $6 per day (Desmond 1). If companies like Nike that claim to be socially responsible exploit workers to this extent, then it shows the extent of exploitative capitalism in the world today. The trend does not end there; several companies are emitting wastes into the water bodies, the air, and causing pollution and global warming. The global warming and pollution effects are evident in the world today because of the capitalistic exploitation by the industry owners (Desmond).

Racism and Racial Inequality

The Africans within the passage are treated inhumanely by the Belgians and creating an image of an antithesis of the European civilization. Conrad prevents racial tendencies by his reference to the African region as primitive and dangerous. This was the racism that was used to justify the European actions to rule over the people of Congo and Africa; A place where they had no right being there. Conrad explains imperialism as “The taking it away from those who have a different complexion or slightly flatter noses than ourselves.” (Conrad,3).   Slave labor also explains the extent of their racial abuse. When Marlow arrives in Congo, he witnesses that the Africans were used for hard, dangerous labor that wouldn’t be done by the whites. He notices that they were dying slowly; they were diseased and starved. Marlow notices that the Africans were thin to the ribs, their joints were like knots, all had an iron collar on them, and all were connected together by Chains (Conrad, 35). It meant that these people were not looked after by their white employers. Marlow’s reference to the Africans also displays racial dehumanization. For example, Marlow refers to the blacks as “Cannibal Shipmates” who came across as “exotic caricatures” (Conrad 16). In explaining his journey up the Congo, Marlow says that it “was like traveling back to the earliest beginnings of the world” and the dancing remnants as a prehistoric man (Conrad 9).

The racism experienced in modern-day is cultural racism, where one culture declares itself as the standard source of all cultural values for the society. This is first experienced all over the world with a high rate of cultural assimilation. The western culture is passed off as the best culture and people are assimilated into it. Instead of assimilation being tow ways, it is directed to the majority, who are the whites (Christian 170). Another method of spreading this cultural racism is by restricting the flow of people of different cultures and races into the country. Modern days have presented the case of restricting the Hispanics, Asians, and some Africans from entering their country. America, for example, is today barring the entry of Mexicans into their country. European countries have also been witnessed to reject refugees from African counties.  Economic racism also exists in the modern world. Africa is still segregated from the other parts of the world economically. They are considered the poorest, least technologically advances, least educated, and prehistoric.

Feminist Perspective in the Book

Conrad represents imperialism as a male based agenda, and women only came through after the men have conquered the regions and established civilization. Women are used on the periphery to aid in the male conquests. For example, Marlow’s Aunt is the one who used her wealth to aid him in joining the Belgian Trading company. Black women in Brussels were used to usher Marlow to the company director before they resume their knitting. The case of Kurtz’s African Mistress furthers this narrative. She is described as beautiful and powerful; even the Congolese men fall at her feet, meaning she is a leader in their native community. But the reader and Marlow, she is just an object of fascination and unknowable. It seems that her alliance with Kurtz was the reason for his success in the region. In most imperialistic stories, the first thing the colonizers do is to take a local mistress, which is not usually consensual. Kurtz would have used her to get to the locals, and thus she was a means to an end as women are generally represented within the narrative.

Modern times have also not been decent to the females. The media still progresses stereotypes against the women in their programs and advertisements. There are lesser women used as superheroes, even in ads. Fashion magazines still present skinny women as the only real women. The women politicians are scrutinized more than their male counterparts in media (Siddique). Within the workplace, women still face problems in progressing in their careers. There is the institutional glass ceiling that bars women from advancing to upper-level management. The women still earn lesser than the males within their same job group. It shows that the sexist structure has a deep routing even in modern times. There is also social inequality within the job selections. Women are directed towards careers in caregiving, unlike the men who are directed into the technical ones (Siddique). In addition to all these, women are still facing violence and exploitation in the form of sexual harassment, rape, and regular domestic violence.


The paradox presented in the book and inhumanity is that there is nothing new, even with the change in times. A book presented within 1899 with a story that exposed the evils of imperialism, racial inequalities, and capitalistic exploitation. After years of critique and analysis, the World has accepted these as forms of evil. Surprisingly, in comparison to today’s experiences, The same problems are in existence. Therefore, the aspects of racial inequality, sexism, and capitalistic exploitations Conrad spoke about are relevant to society today.



Work Cited

Christian, Michelle. “A global critical race and racism framework: Racial entanglements and deep and malleable whiteness.” Sociology of Race and Ethnicity 5.2 (2019): 169-185.

Conrad, Joseph. “Heart of darkness.” Heart of Darkness. Palgrave Macmillan, New York, 1996. 17-95.

Desmond, Matthew. “American Capitalism Is Brutal. You Can Trace That to the Plantation.” The New York Times, 14 Aug. 2019, www.nytimes.com/interactive/2019/08/14/magazine/slavery-capitalism.html?mtrref=www.google.com&gwh=C0174444C504206491EDC11D951CB145&gwt=pay&assetType=REGIWALL.

Siddique, Haroon. “Workplace Gender Discrimination Remains Rife, Survey Finds.” The Guardian, The Guardian, 12 Sept. 2018, www.theguardian.com/world/2018/sep/13/workplace-gender-discrimination-remains-rife-survey-finds.

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Imperialism: Heart of Darkness Joseph Conrad

Instructions:  Develop an essay of 1,000-1,500 words. Be sure to argue a particular point of view in your essay (your thesis) and cite varied examples from the readings in MLA format in order to support your perspective. Include a works cited page. Additional MLA information can be found in Week 3’s and Week 6’s readings. Please submit your essay to the assignment section of the course. This assignment is worth 30% of your final grade.


Up to this point we have discussed the Romantic period and the Victorian era, Modernism and Post-Modernism. You will select one era and in partial fulfillment of Course Objective 4, you will discuss a literary movement in connection with one of our assigned readings.

Select one of the following topics as the focus for your essay:

Your Choice!!!!!
1.     Discuss one work or one author from this course that you believe had the most significant influence on British literary history. Please be sure to maintain third person  perspective.

Imperialism: Heart of Darkness Joseph Conrad

3.     Choose a work of British literature we read in the course. Write a response in which you present arguments for and against the work’s relevance for a person or society in the present day.

Imperialism: Heart of Darkness Joseph Conrad

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Corticosteroid Case Study





Corticosteroids are steroid hormones that are either produced by the body or are human-made. It is a class of drugs that lower inflammation in the body; they also reduce immune system activity. They are commonly prescribed to treat sicknesses such as asthma, arthritis, lupus, and allergies due to their property of easing swelling (Ramsahai, & Wark, 2018). Corticosteroids mimic cortisol, which is a naturally produces hormone produced but the body’s adrenal glands. Cortisol plays a significant role in the body, including immune response, stress, and metabolism. Inhaled corticosteroids are useful controllers of asthma, as they suppress inflammation by switching off multiple inflammatory genes through reversing histone acetylation through the recruitment of histone deacetylase 2. This paper will take at a case study of an Asthma patient using a corticosteroid inhaler.

Corticosteroid Mechanism of Action

Significant advancements have been made in understanding the mechanism of action of corticosteroids. The critical aspect of their mechanism of action relies on the suppression of asthma inflammation, which is best understood through the fundamental mechanism of gene transcription. Many genes are activated and suppressed by corticosteroids, which are relevant in understanding their action in asthma the cellular level; corticosteroids reduce the number of inflammatory cells in the asthmatic airways (Hossny et al. 2016). These include T-lymphocytes, eosinophil, mast cells, and dendritic cells. It performs its function by inhibiting the recruitment of inflammatory cells into the airways. It does this and inhibiting the survival of inflammatory molecules in the airways by suppressing the production of chemotactic mediators and adhesion molecules. It also inhibits the survival of inflammatory cells like T-lymphocytes, eosinophil, and mast cells. ICS suppresses many of the activated inflammatory genes in the airways epithelial cells


Regular ICS restores the integrity of the epithelial cells. The suppression of the mucosal inflammation is very rapid, with a substantial reduction in eosinophil detectable within six hours, further associated with reduced airways hyperresponsiveness. The reversal of the airways hyperresponsiveness may take a couple of months to reach a plateau, which is a probable reflection of structural changes in the airway.

Corticosteroids diffuse across the cell membrane to bind with glucocorticoid receptors in the cytoplasm. Glucocorticoids bind to the cytosolic glucocorticoid receptor. After the hormones bind to the corresponding receptor, the newly formed compound translocates itself to the cell nucleus. It binds to glucocorticoid response elements in the promoter region of the target genes, which results in the regulation of gene expression in a process referred to as transactivation. The resulting protein from the up-regulated genes has a number of effects: anti-inflammatory, secretory leukocyte protease inhibitor: mitogen-activated protein Kinase Phosphatase and increased glucogenesis.

Cause of Fatigue during an asthmatic attack

Hypersensitivity of the airways is the main characteristic of an asthmatic attack. The main symptoms are mainly described as wheezing, coughing, chest tightness, and shortness of breath. Although fatigue and exhaustion are not explicitly characterized as asthma symptoms, they may often be associated with asthma as a general feeling of the patient. It is common for patients with prolonged asthmatic attacks to report to physicians that they feel tired all the time. The common cause of fatigue in asthma patients is due to the deprivation of oxygen or low oxygen levels. An exacerbation of asthma may result in low oxygen levels in the blood, which may intern manifest itself as a feeling of tiredness that persists for the aa asthmatic patient. In patients with poorly controlled asthma, they have characteristics of waking up at night and concomitant fatigue. Inadequate sleep and rest during the night have a subsequent effect during the day, which manifests itself as being tired or feeling exhausted continuously. Persistent coughing and the increased use of one’s accessory muscles during asthma exacerbations may oxygen result in muscle fatigue and, on some occasions, muscle pains. Constant wheezing that accompanies exacerbation has a contribution to the feeling of being weak, fatigued, and tired. The best way to keep the fatigue in check is to keep the asthma under control. Signs that it may e out of control may include frequent use of rescue inhaler, increased cases of shortness of breath, which may limit physical activities and any other symptoms that may be specific to an individual.

The immune system’s abnormal response is at the heart of respiratory symptoms associated with asthma. When an individual is exposed to specific triggers, the immune system overacts and releases chemicals into the bloodstream causing the lungs to function abnormally. Asthmatic attacks are characterized by three distinct features. The first one is the tightening of the muscles in the air passage, which is known as bronchoconstriction. Bronchoconstriction is caused by stimulation of nerve endings by any asthma triggers, which instigates the release of acetylcholine, which acts on the postjunctional cells in the smooth muscles of the lungs hence causing bronchial spasm and the overproduction of mucus. This causes less air to enter the lungs. The second characteristic is the excessive production of mucus, which clogs the air passage and, lastly, inflammation of air passages resulting from an abnormal immune response. Inflammations caused by the antigen-presenting cell being mistakenly identified as threats causing a transformation into defensive cells TH2 that signals the immune to defend itself by inflammation. These physiological actions lead to wheezing, chest tightness, coughing, and shortness of breath that are experienced during an asthmatic attack.




Hypercapnia is a typical result of respiratory fatigue. Patel, Miao, & Majmundar (2020) indicate that it is usually associated with hypoventilation and increased dead space in which the alveoli are ventilated, but they are not perfused. There is often an accumulation of CO2, which causes a drop in the pH that may lead to a state of respiratory acidosis. The chemoreceptor reflex is essential in allowing the body to respond to the increased COZ level in the body. When the body is in the state of Hypercapnia, central chemoreceptors activities increase. The result is the sympathetic outflow t the vasculature is increased while at the same time efforts are made to increase respiratory rate.

Hypercapnia has a number of physiologic effects. At the cellular level, CO2 readily diffuses across cell membranes. It affects the formation of carbonic acid and the generation of hydrogen ions (Vasileiadis et al., 2019). However, intracellular buffering is rapid as it reaches ninety percent completion within three hours after the onset of Hypercapnia. Acute Hypercapnia increases the discharge of the sympathetic nervous system. As a result, the plasma levels of the epinephrine and norepinephrine rise that leads to increased myocardial contractility and cardiac output and a further increased risk for cardiac arrhythmias. Acute Hypercapnia increases the discharge of the sympathetic nervous system. As a result, the plasma levels of the epinephrine and norepinephrine rise, which leads to increased myocardial contractility and cardiac output and a further increased risk for cardiac arrhythmias.



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Hossny, E., Rosario, N., Lee, B. W., Singh, M., El-Ghoneimy, D., Soh, J. Y., & Le Souef, P. (2016). The use of inhaled corticosteroids in pediatric asthma: update. World Allergy Organization Journal, 9(1), 26.

Patel, S., Miao, J. H., & Majmundar, S. H. (2020). Physiology, carbon dioxide retention. In StatPearls [Internet]. StatPearls Publishing.

Ramsahai, J. M., & Wark, P. A. (2018). Appropriate use of oral corticosteroids for severe asthma. Medical Journal of Australia, 209(S2), S18-S21.

Vasileiadis, I., Alevrakis, E., Ampelioti, S., Vagionas, D., Rovina, N., & Koutsoukou, A. (2019). Acid-Base Disturbances in Patients with Asthma: A Literature Review and Comments on Their Pathophysiology. Journal of Clinical Medicine, 8(4), 563.

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Case Study 3: Disorders of Ventilation and Gas Exchange

Case Study 3: Disorders of Ventilation and Gas Exchange

Emmanuel and his mother live in an urban community housing complex. The building is worn down and dirty from the urban dust, cockroaches, and mold. Emmanuel is 5 years of age and has suffered from asthma for the last 2 years. One evening, his mother poured him some milk and put him to bed. Shortly afterward, Emmanuel woke up wheezing and coughing. As he gasped for air, he became more and more anxious. His mother ran for his inhaler, but he was too upset and restless to use it. Emmanuel?s skin became moist with sweat, and as he began to tire, his wheezing became quieter. His mother called 911 and waited anxiously for the ambulance to arrive.

  1. Emmanuel uses a corticosteroid inhaler for the management of his asthma.
  2. What is the mechanism of action of this drug? and How is its action different from the ?2-agonist inhalants?
  3. Why does someone with severe asthma become physically fatigued during a prolonged attack?  and What are the physiologic events that occur during an attack?
  4. One of the complications of respiratory fatigue is the development of hypercapnia.  How does the body compensate for an increase in CO2?
  5. What are the effects of hypercapnia on the central nervous system?


Case Study Assignment Requirements

  1. Please address each question asked in the case study.
  2. Cite at least three references in your case study paper; this may include peer-reviewed journal articles, textbooks, or evidence-based practice websites to support the content.
  3. All reference sources must be within 5 years.
  4. Do not use sources such as Wikipedia or UpToDate as a reference.
  5. Assignments must be at least four full pages of analytic content, double-spaced (the cover and reference pages do not count in the page count, but must be included with the assignment), and follow APA 7th edition forma

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Cushing Disease Case Study



Cushing Disease Case Study


Cushing disease is a condition caused by excess hormone cortisol in the blood level. The excess cortisol in the blood is caused by a pituitary tumor that secretes adrenocorticotropic (ACTH). Adrenocorticotropic is a hormone produced by the pituitary glands. ACTH stimulates the adrenal glands to produce cortisol (Fleseriu, 2015). The diagnosis of the disease may sometimes be difficult since the body changes are not rapid, and symptoms develop slowly. On many occasions, the hormone elevation may be periodic. The first step in diagnosis is establishing a state of excess blood cortisol, which is typically done by hormone testing. After the establishment of this, an MRI is done to establish if a pituitary tumor is present. There are several tests that can be used to diagnose the Cushing disease, including; urine test, blood, saliva test, imaging test, and Petrosal sinus sampling. This paper will examine a case study of a patient with Cushing disease, taking an in-depth look at the use of a 24-hour free cortisol urine test and an overnight dexamethasone suppression test.

Dexamethasone Test

Overnight dexamethasone test checks to see how dexamethasone changes the level of cortisol in the blood. The test is aimed to check for a condition in which the adrenal gland produces excessive amounts of cortisol. In normal cases, when the pituitary gland produces less ACTH, the adrenal gland will make less cortisol. Dexamethasone is like cortisol, functions to lower the amount of ACTH released by the pituitary gland, hence lowering the amount of cortisol released by the adrenal glands. In people who have Cushing syndrome, cortisol levels may stay very high after the administration of a dose of dexamethasone. There are cases where other conditions may keep the cortisol levels high. Examples are in cases of depression, alcohol use disorder, obesity, stress, kidney failure, uncontrolled diabetes, and pregnancy.

The test is performed when the overproduction of cortisol is suspected in an individual. The two-dose set- low and high dose- can help to differentiate healthy people from those who produce too much cortisol. High dose test may e used to determine if the pituitary gland is abnormal. Giving dexamethasone should reduce ACTH levels, which should result in reduced cortisol levels. Individuals with an abnormality in their pituitary glands will produce too much ACTH hence having an abnormal response to low dose tests but have a normal response to high dose tests.

How steroid Hormones are Metabolized

Steroid hormones are steroids that act like hormones and can be grouped into two classes; corticosteroids and sex steroids. According to the receptor to which they bind, there are a further five more types from the two classes. Steroid hormones help control metabolism, immune function, inflammation, development of sexual characteristics, salt and water balance, and the ability to withstand injury and illness.

The synthesis of steroid hormones mainly takes place in the adrenal gland and the gonads (Cole, Short, & Hooper, 2019). All steroid is synthesized from cholesterol. Their synthesis is largely regulated at the initial steps of cholesterol mobilization and transport into the mitochondrial matrix for conversion to pregnenolone. The role of pregnenolone is tissue specific. In the zona fasciculata, the adrenal cortex is converted into cortisol, the gonads to testosterone, the zona glomerulosa to aldosterone, and estrone to estradiol. They are lipids so they can pass through the cell membrane because they are fat-soluble and bind with steroid hormone receptors that bring about change within the cell. They are generally carried in the blood, bound to specific proteins. Further conversions and catabolism occur in the liver, target tissues, and in other peripheral tissues.


24-hour Urine Test

A 24-hour urine test is a simple lab test set to measure the contents of the urine. It is done by collecting urine over the full period of 24 hours. A 24-hour urine hormone testing has long been established as a reliable method used in evaluating the production of steroid hormones and their metabolites. In the case of Cushing disease, the test measures the level of the hormone cortisol in the urine.

The 24-hour urine test tends to be more comprehensive than any other type of cortisol test. It measures the total amounts of cortisol excreted into the urine over 24 hours. Other tests like a blood test, Saliva test only measure cortisol levels at a particular time (Raff, 2015). This may make the results not to be precise. It also helps to give vital information to doctor like how much urine your body produces in a day and how much of the cortisol is contained in it at different times of the day. A simple specimen urinalysis cannot provide this vital information; hence patience is instructed to collect all their urine in 24 hours.

Differences Between the Mechanism of Action of ACTH and Cortisol on Target Cells

ACTH stimulates the secretion of glucocorticoid that are steroid hormones from the adrenal cortex, especially in the zona and fasciculata of the adrenal glands. It acts by binding to the cell surface ACTH receptors located primarily on the adrenocortical cells of the adrenal cortex (Gallo-Payet, Martinez, & Lacroix, 2017). On ligand binding, the receptor undergoes conformation changes that consequently stimulate the receptor, which stimulates the enzyme adenylyl cyclase, leading to an increase in intracellular cyclic adenosine monophosphate and subsequent activation of protein kinase. It influences the secretion of hormones by both the rapid, short-term mechanism and long-term actions. ACTH further stimulates the uptake of lipoprotein into cortical cells. This serves to increase the bioavailability of cholesterol in the adrenal cortex cells.


Cortisol is a major glucocorticoid in human beings. It has two primary actions, which include a breakdown of protein and fat so that it provides metabolites that can convert to glucose in the liver. It also activates anti stressor and anti-inflammatory pathways. Moreover, it has weak mineralocorticoid activity. It plays a major role in the body’s response to stress. It maintains blood glucose concentration by increasing gluconeogenesis and blocking uptake of glucose into tissue other than the central nervous system. It further contributes to the maintenance of the body’s blood pressure by augmenting the concretive effects of catecholamines of blood vessels.


The exposure of the body to high levels of the hormone cortisol for a long time leads to Cushing disease. The condition may also occur when your body makes too much cortisol on its own. There are several diagnoses for the disease; however, a 24-hour urine test is most effective as it is more comprehensive measuring total number or cortisol excreted in 24 hours. This test makes the results to be more precise while at the same time offering other important information to the doctor about the patient.


Fleseriu, M. (2015). Medical treatment of Cushing disease: new targets, new hope. Endocrinology and Metabolism Clinics, 44(1), 51-70.

Cole, T. J., Short, K. L., & Hooper, S. B. (2019, June). The science of steroids. In Seminars in Fetal and Neonatal Medicine (Vol. 24, No. 3, pp. 170-175). WB Saunders.

Raff, H. (2015). Cushing syndrome: update on testing. Endocrinology and Metabolism Clinics, 44(1), 43-50.

Gallo-Payet, N., Martinez, A., & Lacroix, A. (2017). ACTH action in the Adrenal Cortex: From Molecular Biology to Pathophysiology. Frontiers in Endocrinology, 8, 101.

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Mechanisms of Endocrine Control

Leda is a 38-year-old woman who began to experience weight gain, mood swings, and weakness. When her periods became irregular, she went to her physician. Leda?s physician heard the symptoms Leda was concerned about and then ordered a 24-hour free cortisol urine test and an overnight dexamethasone suppression test and measured her serum adrenocorticotropic (ACTH) levels. The results indicated that Leda had Cushing disease, a condition caused by the hypersecretion of ACTH by the anterior pituitary and resulting in elevated cortisol levels. To confirm the diagnosis, Leda?s physician ordered a cranial MRI to identify the presence of a pituitary tumor.

1.     The dexamethasone test involves the administration of a synthetic glucocorticoid (i.e., cortisol). Knowing what you do about negative feedback mechanisms, how might this test be used to assess pituitary function?

2.     Describe how the steroid hormones, like cortisol, are metabolized in the body.

3.     What are the advantages of using a 24-hour urine test to measure this hormone?

4.     Protein-based and steroid-based hormones trigger cellular responses in different ways. What are the differences between the mechanism of action of ACTH and cortisol on target cells?




5.     Make sure all of the topics in the case study have been addressed.

6.     Cite at least four references in your case study paper; this may include peer-reviewed journal articles, textbooks, or evidence-based practice websites to support the content. Please provide an in-text citation

7.     All reference sources must be within 5 years.

8.     Do not use sources such as Wikipedia or UpToDate as a reference.

9.     Assignments must have at least four full pages of analytic content, double-spaced (the cover and reference pages do not count in the page count, but must be included with the assignment), and follow APA 7th edition format.

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