Are you knowledgeable in Anatomy, Medicine, or Diseases? If so PLEASE help with CASE STUDY.?I'M IN THE PROCESS OF DOING A CASE STUDY FOR MY A&P CLASS. THE CASE STUDY READS AS FOLLOWS:
Doctor, Your patient is Alex J, a 45-year-old male from the Midwest. It is February. He has the following symptoms: weakness, fatigue, hypotension, weight loss, dehydration, and decreased cold tolerance. He has also noticed an increased pigmentation (tanning) of both exposed and nonexposed portions of the body and back. The doctor performed a plasma cortisol determination test.
His blood chemistry values follow:
Serum sodium 128 mEq/Lv
Serum potassium 6.3 mEq/L
Fasting blood glucose 65 mg/dL
BUN 4.5 mg/dL
Serum creatinine 0.5 mg/dL
Hematology tests resulted in the following values:
Hematocrit 50%
Leukocytes 5000/cu mm
A plasma cortisol determination indicated a low cortisol level. Following administration of ACTH, plasma cortisol did not rise significantly after sixty and ninety minutes. Endogenous circulating levels of ACTH were later determined to be significantly elevated.
1. What endocrine organ is the site of the malfunction?
2. What is the name of this disorder? Use all available information to support your diagnosis.
3. Discuss the electrolyte disturbances resulting from this disorder. elaborate
4. Discuss the metabolic disturbances resulting from this disorder. elaborate
5. What is the cause of the tanning?
-WHAT I'VE CAME UP WITH SO FAR IS:
1) Adrenal Gland
2) Addison's Disease
3) The sodium is low, and the potassium is high because of the lack of aldosterone to control the levels in the kidneys. The low BUN makes no sense for Addison's though...Not sure if that is a typo. BUN should be high, not low if it is Addison's
4) Oh there is a lot here. Since the hypothalamus is not being turned off by cortisol, it makes an abundance of CRH which lowers blood sugar, and induces stress. There is also low blood pressure because of the lack of angiotensin. So basically the glucocorticoids responsible for deactivating the hypothalamus and pituitary are not present, so both organs produce hormones without negative feedback.
5) Decreased glucocorticoid levels will cause the pituitary to release a lot of ACTH. ACTH is turned into MSH which signals the melanocytes to produce melanin, and therefore pigment.
The patient has Addison's Disease. It is often caused by autoimmune destruction of the adrenal gland.
---IF YOU KNOW YOU'RE STUFF CAN YOU LET ME KNOW IF I'M ON THE RIGHT TRACK, & HELP WITH A BIT MORE INFORMATION THAT I MAY BE MISSING. STILL DOING RESEARCH BUT ALITTLE HELP WILL BE GREATLY APPRECIATED!
Posted by Jen S
1. yes.
2. yes.
3. BUN can be high for dehydration. That can happen when the person has low cortisol and the body is not managing fluids well.
4. lack of cortisol leads to a lack of energy, normal metabolism. Renin, aldosterone and or DHEA may be impaired.
5. The first 15 molecules of ACTH are identical to melanin, so the higher the ACTH, the higher the melanin.
Posted by defensewinschampionships
I agree with 1, 2, and 3, and 5. On number 4, the low glucose levels are related to the lack of cortisol. Cortisol raises blood sugar. Also, the low blood pressure is a combination of two things. Cortisol raises blood pressure, and it is very low. Also, aldosterone isn't being produced, which causes a lower blood volume and blood pressure. I don't think the CRH plays a major role here.
Posted by tyro
1 and 2 are right
for 3, the only thing id add is that aldosterone does impact your kidneys filtering ability and you can see a drop in bun with that
4. your talking about two things
a) low blood sugar-which comes from low cortisol production by adrenals leading to fatigue and depression
b)low blood volume- which comes from low aldosterone, which you mentioned
you didnt mention low sex drive(men and women), and problems with mentruation(women) and pregancy(women;
the adrenal gland has 3 layers(GFR)
zona glomerulosa - outermost zone-makes aldosterone
zona fasiculata -, middle zone,makes cortisol
zona reticularis - thin, inner zone makes sex hormone
the mnemonic i like to remember this is: the deeper you go the sweeter it gets, think about sex
fyi,name a famous person with addisons? jfk
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