Endocrine Case Studies – Flashcards

A 19-year old BCTC student was admitted to the UK Medical Center because of extreme fatigue and weight loss. For the previous year he had tired easily, had lost 64 pounds in the last 2 years, his present height is 71 inches and his weight 140 pounds. About 4 years previously, he began to urinate frequently at night, and since then had increasing thirst and high urine output. He came to the hospital because during the last 24 hours he was extremely thirsty and irritable, and drank about twelve 360 ml glasses of water. He was urinating hourly during the last 24 hour period and unable to get enough to drink. His gums were sore and he had recent difficulty eating because of the gum tenderness. *Results of physical exam: * Plasma glucose: 435 mg/dl (normal: 60-100) Urine: specific gravity: 1.035 (normal: 1.015 - 1.022); 4+ reaction for glucose, moderate reaction for acetone Plasma: pH = 7.25 (normal: 7.35-7.45) PCO2 = 30 mmHg (normal: 35-45) HCO3- = 14 mEq/L (normal: 22-26) Hematocrit: 55% (normal: 40-50) Blood pressure: 105/50 standing; 130/68 lying down Standing pulse 104/min (normal: < 80) Respiration: 20 breaths/min (normal: 12) *What condition does our BCTC student have?*

A 19-year old BCTC student was admitted to the UK Medical Center because of extreme fatigue and weight loss. For the previous year he had tired easily, had lost 64 pounds in the last 2 years, his present height is 71 inches and his weight 140 pounds. About 4 years previously, he began to urinate frequently at night, and since then had increasing thirst and high urine output. He came to the hospital because during the last 24 hours he was extremely thirsty and irritable, and drank about twelve 360 ml glasses of water. He was urinating hourly during the last 24 hour period and unable to get enough to drink. His gums were sore and he had recent difficulty eating because of the gum tenderness. *Results of physical exam: * Plasma glucose: 435 mg/dl (normal: 60-100) Urine: specific gravity: 1.035 (normal: 1.015 - 1.022); 4+ reaction for glucose, moderate reaction for acetone Plasma: pH = 7.25 (normal: 7.35-7.45) PCO2 = 30 mmHg (normal: 35-45) HCO3- = 14 mEq/L (normal: 22-26) Hematocrit: 55% (normal: 40-50) Blood pressure: 105/50 standing; 130/68 lying down Standing pulse 104/min (normal: < 80) Respiration: 20 breaths/min (normal: 12) *Why might he lose weight when his plasma glucose is up?*

A 19-year old BCTC student was admitted to the UK Medical Center because of extreme fatigue and weight loss. For the previous year he had tired easily, had lost 64 pounds in the last 2 years, his present height is 71 inches and his weight 140 pounds. About 4 years previously, he began to urinate frequently at night, and since then had increasing thirst and high urine output. He came to the hospital because during the last 24 hours he was extremely thirsty and irritable, and drank about twelve 360 ml glasses of water. He was urinating hourly during the last 24 hour period and unable to get enough to drink. His gums were sore and he had recent difficulty eating because of the gum tenderness. *Results of physical exam: * Plasma glucose: 435 mg/dl (normal: 60-100) Urine: specific gravity: 1.035 (normal: 1.015 - 1.022); 4+ reaction for glucose, moderate reaction for acetone Plasma: pH = 7.25 (normal: 7.35-7.45) PCO2 = 30 mmHg (normal: 35-45) HCO3- = 14 mEq/L (normal: 22-26) Hematocrit: 55% (normal: 40-50) Blood pressure: 105/50 standing; 130/68 lying down Standing pulse 104/min (normal: < 80) Respiration: 20 breaths/min (normal: 12) *What is his acid-base disturbance?*

A 19-year old BCTC student was admitted to the UK Medical Center because of extreme fatigue and weight loss. For the previous year he had tired easily, had lost 64 pounds in the last 2 years, his present height is 71 inches and his weight 140 pounds. About 4 years previously, he began to urinate frequently at night, and since then had increasing thirst and high urine output. He came to the hospital because during the last 24 hours he was extremely thirsty and irritable, and drank about twelve 360 ml glasses of water. He was urinating hourly during the last 24 hour period and unable to get enough to drink. His gums were sore and he had recent difficulty eating because of the gum tenderness. *Results of physical exam: * Plasma glucose: 435 mg/dl (normal: 60-100) Urine: specific gravity: 1.035 (normal: 1.015 - 1.022); 4+ reaction for glucose, moderate reaction for acetone Plasma: pH = 7.25 (normal: 7.35-7.45) PCO2 = 30 mmHg (normal: 35-45) HCO3- = 14 mEq/L (normal: 22-26) Hematocrit: 55% (normal: 40-50) Blood pressure: 105/50 standing; 130/68 lying down Standing pulse 104/min (normal: < 80) Respiration: 20 breaths/min (normal: 12) *. Explain his respiratory rate, how does it relate to his acid-base disturbance?*

A 19-year old BCTC student was admitted to the UK Medical Center because of extreme fatigue and weight loss. For the previous year he had tired easily, had lost 64 pounds in the last 2 years, his present height is 71 inches and his weight 140 pounds. About 4 years previously, he began to urinate frequently at night, and since then had increasing thirst and high urine output. He came to the hospital because during the last 24 hours he was extremely thirsty and irritable, and drank about twelve 360 ml glasses of water. He was urinating hourly during the last 24 hour period and unable to get enough to drink. His gums were sore and he had recent difficulty eating because of the gum tenderness. *Results of physical exam: * Plasma glucose: 435 mg/dl (normal: 60-100) Urine: specific gravity: 1.035 (normal: 1.015 - 1.022); 4+ reaction for glucose, moderate reaction for acetone Plasma: pH = 7.25 (normal: 7.35-7.45) PCO2 = 30 mmHg (normal: 35-45) HCO3- = 14 mEq/L (normal: 22-26) Hematocrit: 55% (normal: 40-50) Blood pressure: 105/50 standing; 130/68 lying down Standing pulse 104/min (normal: < 80) Respiration: 20 breaths/min (normal: 12) *Explain what causes his high urine output.*

A 19-year old BCTC student was admitted to the UK Medical Center because of extreme fatigue and weight loss. For the previous year he had tired easily, had lost 64 pounds in the last 2 years, his present height is 71 inches and his weight 140 pounds. About 4 years previously, he began to urinate frequently at night, and since then had increasing thirst and high urine output. He came to the hospital because during the last 24 hours he was extremely thirsty and irritable, and drank about twelve 360 ml glasses of water. He was urinating hourly during the last 24 hour period and unable to get enough to drink. His gums were sore and he had recent difficulty eating because of the gum tenderness. *Results of physical exam: * Plasma glucose: 435 mg/dl (normal: 60-100) Urine: specific gravity: 1.035 (normal: 1.015 - 1.022); 4+ reaction for glucose, moderate reaction for acetone Plasma: pH = 7.25 (normal: 7.35-7.45) PCO2 = 30 mmHg (normal: 35-45) HCO3- = 14 mEq/L (normal: 22-26) Hematocrit: 55% (normal: 40-50) Blood pressure: 105/50 standing; 130/68 lying down Standing pulse 104/min (normal: < 80) Respiration: 20 breaths/min (normal: 12) *Explain his hematocrit.*

A 19-year old BCTC student was admitted to the UK Medical Center because of extreme fatigue and weight loss. For the previous year he had tired easily, had lost 64 pounds in the last 2 years, his present height is 71 inches and his weight 140 pounds. About 4 years previously, he began to urinate frequently at night, and since then had increasing thirst and high urine output. He came to the hospital because during the last 24 hours he was extremely thirsty and irritable, and drank about twelve 360 ml glasses of water. He was urinating hourly during the last 24 hour period and unable to get enough to drink. His gums were sore and he had recent difficulty eating because of the gum tenderness. *Results of physical exam: * Plasma glucose: 435 mg/dl (normal: 60-100) Urine: specific gravity: 1.035 (normal: 1.015 - 1.022); 4+ reaction for glucose, moderate reaction for acetone Plasma: pH = 7.25 (normal: 7.35-7.45) PCO2 = 30 mmHg (normal: 35-45) HCO3- = 14 mEq/L (normal: 22-26) Hematocrit: 55% (normal: 40-50) Blood pressure: 105/50 standing; 130/68 lying down Standing pulse 104/min (normal: < 80) Respiration: 20 breaths/min (normal: 12) *Explain why his pulse rate is high upon standing.*

A 19-year old BCTC student was admitted to the UK Medical Center because of extreme fatigue and weight loss. For the previous year he had tired easily, had lost 64 pounds in the last 2 years, his present height is 71 inches and his weight 140 pounds. About 4 years previously, he began to urinate frequently at night, and since then had increasing thirst and high urine output. He came to the hospital because during the last 24 hours he was extremely thirsty and irritable, and drank about twelve 360 ml glasses of water. He was urinating hourly during the last 24 hour period and unable to get enough to drink. His gums were sore and he had recent difficulty eating because of the gum tenderness. *Results of physical exam: * Plasma glucose: 435 mg/dl (normal: 60-100) Urine: specific gravity: 1.035 (normal: 1.015 - 1.022); 4+ reaction for glucose, moderate reaction for acetone Plasma: pH = 7.25 (normal: 7.35-7.45) PCO2 = 30 mmHg (normal: 35-45) HCO3- = 14 mEq/L (normal: 22-26) Hematocrit: 55% (normal: 40-50) Blood pressure: 105/50 standing; 130/68 lying down Standing pulse 104/min (normal: < 80) Respiration: 20 breaths/min (normal: 12) *Discuss his ADH levels. Explain why they are high or low.*

A 19-year old BCTC student was admitted to the UK Medical Center because of extreme fatigue and weight loss. For the previous year he had tired easily, had lost 64 pounds in the last 2 years, his present height is 71 inches and his weight 140 pounds. About 4 years previously, he began to urinate frequently at night, and since then had increasing thirst and high urine output. He came to the hospital because during the last 24 hours he was extremely thirsty and irritable, and drank about twelve 360 ml glasses of water. He was urinating hourly during the last 24 hour period and unable to get enough to drink. His gums were sore and he had recent difficulty eating because of the gum tenderness. *Results of physical exam: * Plasma glucose: 435 mg/dl (normal: 60-100) Urine: specific gravity: 1.035 (normal: 1.015 - 1.022); 4+ reaction for glucose, moderate reaction for acetone Plasma: pH = 7.25 (normal: 7.35-7.45) PCO2 = 30 mmHg (normal: 35-45) HCO3- = 14 mEq/L (normal: 22-26) Hematocrit: 55% (normal: 40-50) Blood pressure: 105/50 standing; 130/68 lying down Standing pulse 104/min (normal: < 80) Respiration: 20 breaths/min (normal: 12) *What would be a possible treatment for his condition?*

A 45-year old male from the Midwest presented with the following symptoms during February: weakness, fatigue, orthostatic hypotension, weight loss, dehydration, and decrease cold tolerance. His blood chemistry values follow: Serum sodium 128 mEq/L normal 136-139 Serum potassium 6.3 mEq/L normal 3.5-5.0 Fasting blood glucose 65 mg/dL normal 70-110 Hematocrit: 50 % Leukocytes: 5,000 mm3 He also noticed increased pigmentation (tanning) of both exposed and nonexposed portions of this body and back. A plasma cortisol determination indicated a low cortisol level. Following administration of ACTH, plasma cortisol did not rise significantly after sixty to ninety minutes. Endogenous circulating levels of ACTH were later determined to significantly elevated. *What endocrine organ is the site of the malfunction?*

A 45-year old male from the Midwest presented with the following symptoms during February: weakness, fatigue, orthostatic hypotension, weight loss, dehydration, and decrease cold tolerance. His blood chemistry values follow: Serum sodium 128 mEq/L normal 136-139 Serum potassium 6.3 mEq/L normal 3.5-5.0 Fasting blood glucose 65 mg/dL normal 70-110 Hematocrit: 50 % Leukocytes: 5,000 mm3 He also noticed increased pigmentation (tanning) of both exposed and nonexposed portions of this body and back. A plasma cortisol determination indicated a low cortisol level. Following administration of ACTH, plasma cortisol did not rise significantly after sixty to ninety minutes. Endogenous circulating levels of ACTH were later determined to significantly elevated. *Is this a primary or secondary disturbance? How do you know?*

A 45-year old male from the Midwest presented with the following symptoms during February: weakness, fatigue, orthostatic hypotension, weight loss, dehydration, and decrease cold tolerance. His blood chemistry values follow: Serum sodium 128 mEq/L normal 136-139 Serum potassium 6.3 mEq/L normal 3.5-5.0 Fasting blood glucose 65 mg/dL normal 70-110 Hematocrit: 50 % Leukocytes: 5,000 mm3 He also noticed increased pigmentation (tanning) of both exposed and nonexposed portions of this body and back. A plasma cortisol determination indicated a low cortisol level. Following administration of ACTH, plasma cortisol did not rise significantly after sixty to ninety minutes. Endogenous circulating levels of ACTH were later determined to significantly elevated. *What is the name of this disorder?*

A 45-year old male from the Midwest presented with the following symptoms during February: weakness, fatigue, orthostatic hypotension, weight loss, dehydration, and decrease cold tolerance. His blood chemistry values follow: Serum sodium 128 mEq/L normal 136-139 Serum potassium 6.3 mEq/L normal 3.5-5.0 Fasting blood glucose 65 mg/dL normal 70-110 Hematocrit: 50 % Leukocytes: 5,000 mm3 He also noticed increased pigmentation (tanning) of both exposed and nonexposed portions of this body and back. A plasma cortisol determination indicated a low cortisol level. Following administration of ACTH, plasma cortisol did not rise significantly after sixty to ninety minutes. Endogenous circulating levels of ACTH were later determined to significantly elevated. *Discuss the electrolyte disturbances resulting from this disorder (normal vs. diseased).*

A 45-year old male from the Midwest presented with the following symptoms during February: weakness, fatigue, orthostatic hypotension, weight loss, dehydration, and decrease cold tolerance. His blood chemistry values follow: Serum sodium 128 mEq/L normal 136-139 Serum potassium 6.3 mEq/L normal 3.5-5.0 Fasting blood glucose 65 mg/dL normal 70-110 Hematocrit: 50 % Leukocytes: 5,000 mm3 He also noticed increased pigmentation (tanning) of both exposed and nonexposed portions of this body and back. A plasma cortisol determination indicated a low cortisol level. Following administration of ACTH, plasma cortisol did not rise significantly after sixty to ninety minutes. Endogenous circulating levels of ACTH were later determined to significantly elevated. *Discuss the glucose disturbances resulting from this disorder (normal vs. diseased).*

A 45-year old male from the Midwest presented with the following symptoms during February: weakness, fatigue, orthostatic hypotension, weight loss, dehydration, and decrease cold tolerance. His blood chemistry values follow: Serum sodium 128 mEq/L normal 136-139 Serum potassium 6.3 mEq/L normal 3.5-5.0 Fasting blood glucose 65 mg/dL normal 70-110 Hematocrit: 50 % Leukocytes: 5,000 mm3 He also noticed increased pigmentation (tanning) of both exposed and nonexposed portions of this body and back. A plasma cortisol determination indicated a low cortisol level. Following administration of ACTH, plasma cortisol did not rise significantly after sixty to ninety minutes. Endogenous circulating levels of ACTH were later determined to significantly elevated. *What is the cause of the tanning?*

A 45-year old male from the Midwest presented with the following symptoms during February: weakness, fatigue, orthostatic hypotension, weight loss, dehydration, and decrease cold tolerance. His blood chemistry values follow: Serum sodium 128 mEq/L normal 136-139 Serum potassium 6.3 mEq/L normal 3.5-5.0 Fasting blood glucose 65 mg/dL normal 70-110 Hematocrit: 50 % Leukocytes: 5,000 mm3 He also noticed increased pigmentation (tanning) of both exposed and nonexposed portions of this body and back. A plasma cortisol determination indicated a low cortisol level. Following administration of ACTH, plasma cortisol did not rise significantly after sixty to ninety minutes. Endogenous circulating levels of ACTH were later determined to significantly elevated. *What type of replacement therapy would be required for this individual?*

A 45-year old male from the Midwest presented with the following symptoms during February: weakness, fatigue, orthostatic hypotension, weight loss, dehydration, and decrease cold tolerance. His blood chemistry values follow: Serum sodium 128 mEq/L normal 136-139 Serum potassium 6.3 mEq/L normal 3.5-5.0 Fasting blood glucose 65 mg/dL normal 70-110 Hematocrit: 50 % Leukocytes: 5,000 mm3 He also noticed increased pigmentation (tanning) of both exposed and nonexposed portions of this body and back. A plasma cortisol determination indicated a low cortisol level. Following administration of ACTH, plasma cortisol did not rise significantly after sixty to ninety minutes. Endogenous circulating levels of ACTH were later determined to significantly elevated. *Describe the feedback loop for this endocrine disorder. Where is the loop broken?*

A 38-year old female visits her doctor complaining of chronic fatigue and weakness, especially in her legs. Upon greeting the patient, the doctor notes that although she is mildly obese, there is an unusually round contour to her face. During questioning, he learns that at her recent 20-year high school reunion, nobody recognized her because her face looked so different. Physical examination yields an unusual fat distribution consisting of a hump on the upper back and marked centripedal obesity. Blood pressure is also abnormally high. *What is your diagnosis? Explain how you reached this diagnosis.*

Mr. Jessup, a 55-year old man, is operated on for a cerebral tumor. About a month later, he appears in his physician's office complaining of excessive thirst. He claims to have been drinking about 20 liters of water daily for the past week and voiding nearly continuously. A urine sample is collected, its specific gravity is reported at 1.001. *What is your diagnosis?*

Explain both types of diabetes and how they are different.

Explain both types of diabetes insipidus.

Sharon went to her doctor with the following symptoms: dull facial expressions; droopy eyelids; puffiness of the face; sparse, dry hair; scaly skin; evidence of intellectual impairment; lethargy; a change of personality; bradycardia (60 b/min); a blood pressure of 90/70; anemia (Hct 27); constipation and hypothermia. Plasma concentrations of T3 and T4 were low and TSH levels were elevated. Following administration of exogenous TSH, plasma T3 and T4 did not rise after 2 hours. *What is the disorder?*

Sharon went to her doctor with the following symptoms: dull facial expressions; droopy eyelids; puffiness of the face; sparse, dry hair; scaly skin; evidence of intellectual impairment; lethargy; a change of personality; bradycardia (60 b/min); a blood pressure of 90/70; anemia (Hct 27); constipation and hypothermia. Plasma concentrations of T3 and T4 were low and TSH levels were elevated. Following administration of exogenous TSH, plasma T3 and T4 did not rise after 2 hours. *Is this a primary or secondary disorder?*

Sharon went to her doctor with the following symptoms: dull facial expressions; droopy eyelids; puffiness of the face; sparse, dry hair; scaly skin; evidence of intellectual impairment; lethargy; a change of personality; bradycardia (60 b/min); a blood pressure of 90/70; anemia (Hct 27); constipation and hypothermia. Plasma concentrations of T3 and T4 were low and TSH levels were elevated. Following administration of exogenous TSH, plasma T3 and T4 did not rise after 2 hours. *Would you expect to find a palpable goiter? Explain*

Sharon went to her doctor with the following symptoms: dull facial expressions; droopy eyelids; puffiness of the face; sparse, dry hair; scaly skin; evidence of intellectual impairment; lethargy; a change of personality; bradycardia (60 b/min); a blood pressure of 90/70; anemia (Hct 27); constipation and hypothermia. Plasma concentrations of T3 and T4 were low and TSH levels were elevated. Following administration of exogenous TSH, plasma T3 and T4 did not rise after 2 hours. *Describe the feedback loop involved. Where is the loop broken?*

Sharon went to her doctor with the following symptoms: dull facial expressions; droopy eyelids; puffiness of the face; sparse, dry hair; scaly skin; evidence of intellectual impairment; lethargy; a change of personality; bradycardia (60 b/min); a blood pressure of 90/70; anemia (Hct 27); constipation and hypothermia. Plasma concentrations of T3 and T4 were low and TSH levels were elevated. Following administration of exogenous TSH, plasma T3 and T4 did not rise after 2 hours. *Describe a suitable treatment for Sharon.*