Feb 22, 2022 · Cushing’s disease is a condition in which the body produces too much cortisol. Learn about symptoms and treatment. Price Range: $$. Royal Canin gastrointestinal diet is a low-fat (maximum 9.4% of dry matter) dog food with over 22% protein by dry matter. This product includes digestible proteins and prebiotic fiber to assist digestion. It comes in a 1.5-pound container.Cushing’s Triad case: Secondary head injury. It’s a nice winter afternoon (Midwest winter – that is – a balmy 37°F) and a group of teenagers are playing a recreational game of ice hockey ...What is Cushing's syndrome? Cushing's syndrome is a hormonal disorder. It’s caused when you have high levels of the hormone cortisol over a long time. Cushing's syndrome is fairly rare. It most often affects adults who are 20 to 50 years old. It is sometimes called hypercortisolism.Cushing's disease (hyperadrenocorticism) is a serious health condition in dogs that occurs when the adrenal glands overproduce cortisol (cortisone) in the animal's body. Excess cortisol can put a dog at risk of several serious conditions and illnesses, from kidney damage to diabetes, and can be life-threatening.What Is Cushing's Disease in Horses? Also known as pituitary pars intermedia dysfunction (PPID), Cushing’s disease is the most common endocrine disorder diagnosed in horses. Although Cushing’s disease in horses carries the same name as an similar disorder that affects people and dogs, the disease process is different because the equine ...Cushing's disease (hyperadrenocorticism) is a serious health condition in which the adrenal glands overproduce cortisol (cortisone) in the body. Excess cortisol can put a dog at risk of several serious conditions and illnesses, from kidney damage to diabetes, and can be life-threatening.Cushing syndrome, also known as hypercortisolism, is a condition in which your body overproduces a hormone called cortisol. Cortisol helps to regulate a variety of processes in the body. These processes include: Controlling blood sugar levels. Regulating metabolism. Cushing’s Triad case: Secondary head injury. It’s a nice winter afternoon (Midwest winter – that is – a balmy 37°F) and a group of teenagers are playing a recreational game of ice hockey ...Cushing syndrome, also known as hypercortisolism, is a condition in which your body overproduces a hormone called cortisol. Cortisol helps to regulate a variety of processes in the body. These processes include: Controlling blood sugar levels. Regulating metabolism. The following may contain Chewy links. PetMD is operated by Chewy. Cushing’s disease develops when a dog’s body produces too much of a steroid hormone called cortisol. . Chronically high levels of cortisol in the body leads to recurrent infections, skin problems, a pot-bellied appearance, and increased appetite, thirst, and urinati Jun 9, 2022 · What is Cushing’s disease? “Cushing’s disease is a rare but serious condition that is caused by a pituitary tumour," a specialist from the University of California, Los Angeles (UCLA) pituitary team tells Yahoo Canada. " The gland releases excessive adrenocorticotropic hormones and cortisol into the blood over a long period of time. Cushing's syndrome is a hormonal disorder caused by high levels of the hormone cortisol in your body. It’s also known as hypercortisolism. Cortisol comes from your adrenal glands, which sit on...Jun 7, 2023 · Cushing syndrome happens when the body has too much of the hormone cortisol for a long time. This can result from the body making too much cortisol, or from taking medicines called glucocorticoids, which affect the body the same way as cortisol. Cushing’s syndrome is a rare disorder resulting from prolonged exposure to excess glucocorticoids. Early diagnosis and treatment of Cushing’s syndrome is associated with a decrease in morbidity and mortality. Clinical presentation can be highly variable, and establishing the diagnosis can often be difficult. Surgery (resection of the ...Dec 16, 2019 · The distinction between pseudo-Cushing’s states (PCS) and Cushing’s syndrome (CS) poses a significant clinical challenge even for expert endocrinologists. A patient’s clinical history can sometimes help to distinguish between them (as in the case of alcoholic individuals), but the overlap in clinical and laboratory findings makes it ... Cushing syndrome is a disorder that occurs when your body has a higher than normal level of the hormone cortisol. This hormone is made in the adrenal glands. Too much cortisol can be due to various problems. One such problem is a tumor on one of the adrenal glands. Adrenal tumors release cortisol.Feb 2, 2023 · Cushing’s disease is a condition of excessive production of the hormone cortisol due to a benign tumor of the pituitary gland. Common symptoms include high blood pressure, high blood sugar, fatigue, and body fat accumulation to the face, neck, and abdomen. The wide variety of symptoms and gradual changes in appearance often lead to delayed ... Cushing's syndrome is the result of excessive corticosteroids in the body. The main cause is overproduction of adrenocorticotropin hormone (ACTH) in the pituitary gland. ACTH causes the adrenal glands to produce corticosteroids, so too much of ACTH means too much of corticosteroids. Another main cause is taking long-term external steroids like ...Equine Cushing’s disease is a disorder of the pituitary gland that results in hormonal imbalances, causing a variety of clinical signs: a long, wavy haircoat that fails to shed according to normal seasonal patterns; excessive sweating; lethargy and poor athletic performance; chronic recurrent laminitis; infertility; weight loss; muscle ...Jul 1, 2008 · Cushing’s syndrome (hyperadrenocorticism) occurs when the adrenal gland produces too much cortisol. While cortisol is an essential hormone, elevated levels lead to illness. There are several possible causes to this disease, including a tumor in the pituitary gland or the outer layer of the adrenal gland. May 19, 2022 · Cushing’s triad usually occurs in the late stages of acute head injury. This reflex is usually a normal homeostatic response of the body to prevent brain ischemia. But, unfortunately, this triad is a late indication of increased intracranial pressure. Moreover, this triad also suggests that brainstem herniation is possible. Cushing’s syndrome (CS) is a rare problem caused when the adrenal gland (s) makes too much of a hormone called cortisol. CS is most often due to a tumor or mass found in the pituitary gland, but can also be caused by tumors in the adrenal glands themselves. People with Cushing's syndrome may see their face get round ("moon face"), they gain ...Apr 17, 2015 · Cushing’s syndrome is a rare disorder resulting from prolonged exposure to excess glucocorticoids. Early diagnosis and treatment of Cushing’s syndrome is associated with a decrease in morbidity and mortality. Clinical presentation can be highly variable, and establishing the diagnosis can often be difficult. Surgery (resection of the ... May 27, 2021 · Cushing’s disease is a common endocrine disorder seen in older dogs. It occurs more commonly in female dogs than male dogs, and the average age of diagnosis is between 9 and 11 years of age. Here is a list of the most common symptoms of Cushing’s disease in dogs: Cushing syndrome, first described by Harvey in 1912, refers to signs and symptoms caused by excess free plasma glucocorticoids. Excess glucocorticoids can arise from increased endogenous production or prolonged exposure to exogenous use of glucocorticoid products. While endogenous Cushing syndrome is a rare disease, iatrogenic (drug-related or ...The Cushing reflex is a physiological nervous system response to acute elevations of intracranial pressure (ICP), resulting in the Cushing triad of widened pulse pressure (increasing systolic, decreasing diastolic) bradycardia, and irregular respirations. In the first stage of the Cushing reflex, blood pressure and heart rate rise in response ...Cushing's syndrome is the result of excessive corticosteroids in the body. The main cause is overproduction of adrenocorticotropin hormone (ACTH) in the pituitary gland. ACTH causes the adrenal glands to produce corticosteroids, so too much of ACTH means too much of corticosteroids. Another main cause is taking long-term external steroids like ...Cushing’s disease—also known as hypercortisolism and hyperadrenocorticism—is a serious disease that most affects middle-aged and senior dogs. It can be serious if left untreated. Here’s what you need to know about Cushing’s disease in dogs—from types and symptoms to treatment and care.Oct 11, 2020 · Obesity, diabetes, high blood pressure, depression, and many of the other signs on the list can all contribute to erectile dysfunction. Add that to the hormone disruption caused by Cushing’s in the first place, and it’s a recipe for erectile dysfunction. 15. Difficulty getting pregnant. Mar 20, 2023 · The Cushing reflex (vasopressor response, Cushing reaction, Cushing effect, and Cushing phenomenon) is a physiological nervous system response to acute elevations of intracranial pressure (ICP), resulting in Cushing’s triad of widened pulse pressure (increasing systolic, decreasing diastolic), bradycardia, and irregular respirations. Mar 20, 2023 · The Cushing reflex (vasopressor response, Cushing reaction, Cushing effect, and Cushing phenomenon) is a physiological nervous system response to acute elevations of intracranial pressure (ICP), resulting in Cushing’s triad of widened pulse pressure (increasing systolic, decreasing diastolic), bradycardia, and irregular respirations. Cushing reflex (also referred to as the vasopressor response, the Cushing effect, the Cushing reaction, the Cushing phenomenon, the Cushing response, or Cushing's Law) is a physiological nervous system response to increased intracranial pressure (ICP) that results in Cushing's triad of increased blood pressure, irregular breathing, and ...Cushing’s disease—also known as hypercortisolism and hyperadrenocorticism—is a serious disease that most affects middle-aged and senior dogs. It can be serious if left untreated. Here’s what you need to know about Cushing’s disease in dogs—from types and symptoms to treatment and care.Price Range: $$. Royal Canin gastrointestinal diet is a low-fat (maximum 9.4% of dry matter) dog food with over 22% protein by dry matter. This product includes digestible proteins and prebiotic fiber to assist digestion. It comes in a 1.5-pound container.Cushing is a city in Nacogdoches County, Texas, United States. The population was 612 at the 2010 census. Geography. Cushing is located at (31.813492, –94.840288 ...Jun 9, 2022 · What is Cushing’s disease? “Cushing’s disease is a rare but serious condition that is caused by a pituitary tumour," a specialist from the University of California, Los Angeles (UCLA) pituitary team tells Yahoo Canada. " The gland releases excessive adrenocorticotropic hormones and cortisol into the blood over a long period of time. Cushing’s, which is also known as hypercortisolism and hyperadrenocorticism, can be tricky for a vet to diagnose, because it has the same symptoms as other conditions.Jun 9, 2022 · What is Cushing’s disease? “Cushing’s disease is a rare but serious condition that is caused by a pituitary tumour," a specialist from the University of California, Los Angeles (UCLA) pituitary team tells Yahoo Canada. " The gland releases excessive adrenocorticotropic hormones and cortisol into the blood over a long period of time. Aug 16, 2021 · Cushing’s disease is a disorder characterized by symptoms that include weight gain, changes in skin and body hair, and emotional disturbances. These symptoms develop due to excess production of the hormone cortisol. Cushing’s disease is a specific type of Cushing’s syndrome, which is a broader term that encompasses any health problem ... Overview What is Cushing syndrome? Cushing syndrome is an uncommon condition that happens when your body has too much of a hormone called cortisol. Another word for Cushing syndrome is hypercortisolism. A syndrome is a medical term that refers to a group of signs and symptoms that happen together. Cushing’s syndrome is a disorder that occurs when your body makes too much of the hormone cortisol over a long period of time. Cortisol is sometimes called the “stress hormone” because it helps your body respond to stress. Cortisol also helps maintain blood pressure regulate blood glucose, also called blood sugar reduce inflammation Cushing syndrome, also known as hypercortisolism, is a condition in which your body overproduces a hormone called cortisol. Cortisol helps to regulate a variety of processes in the body. These processes include: Controlling blood sugar levels. Regulating metabolism. May 6, 2022 · Cushing's disease is a metabolic disorder caused by long-term exposure to an excess of the hormone cortisol in the body ( stress hormone). This disorder is caused by an excess of adrenocorticotropic hormone released by the pituitary gland. Cushing’s disease is an uncommon variant of Cushing’s syndrome. Cushing’s syndrome is a rare disorder resulting from prolonged exposure to excess glucocorticoids. Early diagnosis and treatment of Cushing’s syndrome is associated with a decrease in morbidity and mortality. Clinical presentation can be highly variable, and establishing the diagnosis can often be difficult. Surgery (resection of the ...Management of Equine Cushing’s Disease and Equine Metabolic Syndrome . Dana Zimmel, DVM, DACVIM, DABVP . Equine Pars Intermedia Dysfuntion (PPID) also known as Equine Cushing’s Disease . Hyperadrenocorticism is one of the most frequently diagnosed endocrine abnormalities of the horse. It is one of the most common diseases of horses greater than Dec 16, 2019 · The distinction between pseudo-Cushing’s states (PCS) and Cushing’s syndrome (CS) poses a significant clinical challenge even for expert endocrinologists. A patient’s clinical history can sometimes help to distinguish between them (as in the case of alcoholic individuals), but the overlap in clinical and laboratory findings makes it ... Cushing is a city in Payne County, Oklahoma, United States. The population was 8,371 at the 2000 census. The city was established after the Land Run of 1891 by Billy Rae Little. It was named for Marshall Cushing, private secretary to U.S. Postmaster General John Wanamaker. An oil boom that began in 1912 led to the city's development as a ... Usually, the test is done overnight, but it can also be done over 2 days. There are two doses you can take for the test: low dose and high dose. The low-dose test helps you find out if you have ... Cushing’s disease is a condition in which the body produces too much cortisol. Learn about symptoms and treatment.Dec 8, 2022 · In most cases, Cushing's disease begins as subtle changes in behaviour and appearance. The most obvious sign is the lack of a topline. The hair coat may be thin or coarse, and there may be evidence of delayed shedding. Horses with Cushing's disease are usually lethargic. Their appetite and energy levels decrease. May 6, 2022 · Cushing's disease is a metabolic disorder caused by long-term exposure to an excess of the hormone cortisol in the body ( stress hormone). This disorder is caused by an excess of adrenocorticotropic hormone released by the pituitary gland. Cushing’s disease is an uncommon variant of Cushing’s syndrome. Usually, the test is done overnight, but it can also be done over 2 days. There are two doses you can take for the test: low dose and high dose. The low-dose test helps you find out if you have ... Cushing’s disease in dogs is caused by one of three things: A tumor on the pituitary gland at the base of the brain (this gland is responsible for telling the adrenal glands to secrete cortisol).Cushing is a city in Nacogdoches County, Texas, United States. The population was 612 at the 2010 census. Geography. Cushing is located at (31.813492, –94.840288 ... Dec 16, 2019 · The distinction between pseudo-Cushing’s states (PCS) and Cushing’s syndrome (CS) poses a significant clinical challenge even for expert endocrinologists. A patient’s clinical history can sometimes help to distinguish between them (as in the case of alcoholic individuals), but the overlap in clinical and laboratory findings makes it ... Cushing's syndrome is a condition caused by having too much of a hormone called cortisol in your body. It can be serious if it's not treated. Who gets it and why. Cushing's syndrome is uncommon. It mostly affects people who have been taking steroid medicine, especially steroid tablets, for a long time. Steroids contain a synthetic version of ...Cushing's syndrome is the result of excessive corticosteroids in the body. The main cause is overproduction of adrenocorticotropin hormone (ACTH) in the pituitary gland. ACTH causes the adrenal glands to produce corticosteroids, so too much of ACTH means too much of corticosteroids. Another main cause is taking long-term external steroids like ...Management Outlook Cushing syndrome occurs when the body overproduces cortisol. It can cause symptoms, including weight gain and thinning skin. What is Cushing syndrome? Cushing syndrome, or...Cushing’s disease (otherwise known as hyperadrenocorticism) is an overproduction of cortisol in the body. The endocrine system is the system in the body that produces and regulates hormones, such as cortisol. Cortisol is important and critical for many functions in the body, such as responding to stress, modulating the immune system or ...What is Cushing’s Disease? Equine Cushing’s disease is a chronic, progressive endocrine disease seen in middle-aged to senior horses. More accurately labeled pituitary pars intermedia dysfunction, or PPID, this is a disease of the pituitary gland.What is Cushing's syndrome? Cushing's syndrome is a hormonal disorder. It’s caused when you have high levels of the hormone cortisol over a long time. Cushing's syndrome is fairly rare. It most often affects adults who are 20 to 50 years old. It is sometimes called hypercortisolism. What Is Cushing's Disease in Horses? Also known as pituitary pars intermedia dysfunction (PPID), Cushing’s disease is the most common endocrine disorder diagnosed in horses. Although Cushing’s disease in horses carries the same name as an similar disorder that affects people and dogs, the disease process is different because the equine ...Cushing’s Triad case: Secondary head injury. It’s a nice winter afternoon (Midwest winter – that is – a balmy 37°F) and a group of teenagers are playing a recreational game of ice hockey ...Overview What is Cushing syndrome? Cushing syndrome is an uncommon condition that happens when your body has too much of a hormone called cortisol. Another word for Cushing syndrome is hypercortisolism. A syndrome is a medical term that refers to a group of signs and symptoms that happen together.Cushing’s disease is a specific form of Cushing’s syndrome in which a pituitary tumor produces elevated levels of a hormone that directs the adrenal glands to synthesize cortisol. One cause of elevated cortisol levels is the use of oral corticosteroid drugs.For all causes, the incidence of Cushing’s syndrome is 3-8 times higher in women than men and most commonly affects individuals 20-50 years of age. Iatrogenic Cushing’s syndrome is the most common type and is caused by administration of corticosteroids such as prednisone in non-physiologic doses. Exogenous steroids suppress the adrenal ...Cushing's disease is one cause of Cushing's syndrome characterised by increased secretion of adrenocorticotropic hormone (ACTH) from the anterior pituitary (secondary hypercortisolism ). This is most often as a result of a pituitary adenoma (specifically pituitary basophilism) or due to excess production of hypothalamus CRH ( corticotropin ... Dec 8, 2022 · In most cases, Cushing's disease begins as subtle changes in behaviour and appearance. The most obvious sign is the lack of a topline. The hair coat may be thin or coarse, and there may be evidence of delayed shedding. Horses with Cushing's disease are usually lethargic. Their appetite and energy levels decrease. Management of Equine Cushing’s Disease and Equine Metabolic Syndrome . Dana Zimmel, DVM, DACVIM, DABVP . Equine Pars Intermedia Dysfuntion (PPID) also known as Equine Cushing’s Disease . Hyperadrenocorticism is one of the most frequently diagnosed endocrine abnormalities of the horse. It is one of the most common diseases of horses greater than Jun 9, 2022 · What is Cushing’s disease? “Cushing’s disease is a rare but serious condition that is caused by a pituitary tumour," a specialist from the University of California, Los Angeles (UCLA) pituitary team tells Yahoo Canada. " The gland releases excessive adrenocorticotropic hormones and cortisol into the blood over a long period of time. Cushing’s disease, also called hyperadrenocorticism, is a condition caused by having too much cortisol. Cortisol is a hormone found in all mammals that’s responsible for helping the body deal with stress, control blood pressure, and metabolize sugar. When a cat, dog, or human has Cushing’s disease, the excess cortisol in their body then ...39 School StreetAshburnham, MA 01430. Founded in 1865, Cushing is an independent, college preparatory school for girls and boys in grades 9 through 12 and post-graduate. Cushing Academy exists for students and develops curious, creative, and confident learners and leaders. Our beautiful 162-acre campus is located in Ashburnham, Massachusetts ... The most common cause of Cushing syndrome is taking too much glucocorticoid or corticosteroid medicine. This form of Cushing syndrome is called exogenous Cushing syndrome. Prednisone, dexamethasone, and prednisolone are examples of this type of medicine. Glucocorticoids mimic the action of the body's natural hormone cortisol.The most common cause of Cushing syndrome is taking too much glucocorticoid or corticosteroid medicine. This form of Cushing syndrome is called exogenous Cushing syndrome. Prednisone, dexamethasone, and prednisolone are examples of this type of medicine. Glucocorticoids mimic the action of the body's natural hormone cortisol.Cushing's disease (also known as Cushing’s syndrome) is a condition in which the adrenal glands overproduce certain hormones. The medical term for this disease is hyperadrenocorticism. Literally translated, “hyper” means over-active, “adreno” means adrenal gland, and “corticism” refers to the outer part (cortex) of the adrenal gland. What causes Cushing's syndrome and Cushing's disease? Some people with Cushing's syndrome have a benign tumour in part of the brain. This tumour tells the adrenal glands to release cortisol. This condition is known as Cushing's disease. Cushing's syndrome can also be caused by: a tumour of the adrenal gland; overgrowth of the adrenal glands Dec 16, 2019 · The distinction between pseudo-Cushing’s states (PCS) and Cushing’s syndrome (CS) poses a significant clinical challenge even for expert endocrinologists. A patient’s clinical history can sometimes help to distinguish between them (as in the case of alcoholic individuals), but the overlap in clinical and laboratory findings makes it ... Cushing disease is a condition in which the pituitary gland releases too much adrenocorticotropic hormone (ACTH). The pituitary gland is an organ of the endocrine system. Cushing disease is a form of Cushing syndrome . Other forms of Cushing syndrome include exogenous Cushing syndrome, Cushing syndrome caused by adrenal tumor, and ectopic ... Jun 20, 2023 · Cushing's syndrome is caused by too high a level of glucocorticoid in the body. This can be caused by taking steroid medication long-term (the common cause) or by the body making too much cortisol (the main glucocorticoid made by the body). Symptoms usually develop gradually and so the diagnosis (other than that caused by steroid medication ... Cushing syndrome happens when the body has too much of the hormone cortisol for a long time. This can result from the body making too much cortisol, or from taking medicines called glucocorticoids, which affect the body the same way as cortisol.Jul 1, 2008 · Cushing’s syndrome (hyperadrenocorticism) occurs when the adrenal gland produces too much cortisol. While cortisol is an essential hormone, elevated levels lead to illness. There are several possible causes to this disease, including a tumor in the pituitary gland or the outer layer of the adrenal gland. What causes Cushing's syndrome and Cushing's disease? Some people with Cushing's syndrome have a benign tumour in part of the brain. This tumour tells the adrenal glands to release cortisol. This condition is known as Cushing's disease. Cushing's syndrome can also be caused by: a tumour of the adrenal gland; overgrowth of the adrenal glands
Cushing’s disease affects your cat’s adrenal glands. If your cat develops this condition, his adrenal glands will produce more of the hormone cortisol than his body needs. While cortisol is an integral part of overall health, too much can lead to serious illness and even death.. G50 1064 04 016
What is Cushing’s disease? “Cushing’s disease is a rare but serious condition that is caused by a pituitary tumour," a specialist from the University of California, Los Angeles (UCLA) pituitary team tells Yahoo Canada. " The gland releases excessive adrenocorticotropic hormones and cortisol into the blood over a long period of time.Canine pituitary dependent hyperadrenocorticism (PDH), also known as Cushing’s disease, is a common endocrine disorder in older dogs.This disorder is caused by a pituitary adenoma (PA) that secretes inappropriate amounts of adrenocorticotropic hormone (ACTH), which results in bilateral adrenal hyperplasia and disorderly and excessive production of cortisol by the adrenal gland. Cushing’s syndrome is a rare disorder resulting from prolonged exposure to excess glucocorticoids. Early diagnosis and treatment of Cushing’s syndrome is associated with a decrease in morbidity and mortality. Clinical presentation can be highly variable, and establishing the diagnosis can often be difficult. Surgery (resection of the ...Cushing’s disease—also known as hypercortisolism and hyperadrenocorticism—is a serious disease that typically affects middle-aged and senior dogs. It can be serious if left untreated. Here’s what you need to know about Cushing’s disease in dogs—from types and symptoms to treatment and care.Aug 22, 2023 · Cushing’s disease, also known as hyperadrenocorticism, occurs when the body produces too much cortisol. Cortisol is a hormone produced and stored by the adrenals, which are two small glands that are above the kidneys. Cortisol helps the body during times of stress, regulates appropriate body weight, skin condition and tissue structure. What are the most important facts to know about Cushing syndrome? Cushing syndrome is a set of symptoms that result from high cortisol levels. Cushing syndrome has many causes, most commonly glucocorticoid medication use. When Cushing syndrome is caused by an ACTH-producing pituitary tumor, it is called Cushing disease.Dec 8, 2022 · In most cases, Cushing's disease begins as subtle changes in behaviour and appearance. The most obvious sign is the lack of a topline. The hair coat may be thin or coarse, and there may be evidence of delayed shedding. Horses with Cushing's disease are usually lethargic. Their appetite and energy levels decrease. Cushing reflex (also referred to as the vasopressor response, the Cushing effect, the Cushing reaction, the Cushing phenomenon, the Cushing response, or Cushing's Law) is a physiological nervous system response to increased intracranial pressure (ICP) that results in Cushing's triad of increased blood pressure, irregular breathing, and ... Cushing disease is a specific type of Cushing syndrome. It occurs when a pituitary tumor causes the body to make too much cortisol. Cushing disease is the most common form of endogenous (from the body) Cushing syndrome, and makes up about 70% of Cushing syndrome cases.Cushing's syndrome is the result of excessive corticosteroids in the body. The main cause is overproduction of adrenocorticotropin hormone (ACTH) in the pituitary gland. ACTH causes the adrenal glands to produce corticosteroids, so too much of ACTH means too much of corticosteroids. Another main cause is taking long-term external steroids like ... .