TA Case Study - BENG140B Sample Case Study May 21,...

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Unformatted text preview: BENG140B Sample Case Study May 21, 2010 Outline •  Case Details –  Medical History –  Physical Exam –  Laboratory Tests •  Diagnosis •  Treatment/Prognosis •  Physiological IntegraIon Case Study Medical History: Susan Oglesby is a 41 year old Caucasian mother of two teenagers. She has always been in excellent health. She recently saw her physician because of several unexplained symptoms, including weight loss of 15 lb, extreme faIgue, and decreased body hair in the axillary and pubic regions. In addiIon, her skin was very tanned, even though she had not been in the sun. Physical Exam: In her physician’s office, Susan appeared very thin, with sunken eyes and decreased skin turgor. When she was supine, her blood pressure was 90/60 and her pulse rate was 95 beats / min. When she was standing, her blood pressure was 70/35 and her pulse rate was 120 beats/min. Her skin was deeply pigmented, especially her nipples and the creases in the palms of her hands. Susan’s physician ordered laboratory tests. ACTH sImulaIon test was negaIve. Test Na+ K+ Osmolarity CorIsol Aldosterone ACTH pH HCO3 ­ Value 126 mEq/L 5.7 mEq/L 265 mOsm/L Decreased Decreased Increased 7.32 18 mEq/L Glucose (fasIng) 50 mg/dl Case Details •  History –  41 yo Caucasian woman –  weight loss of 15 lb –  extreme faIgue –  decreased body hair in the axillary and pubic regions –  previously in excellent health Case Details •  PE –  Skin hyperpigmentaIon –  Very thin –  Sunken eyes –  Decreased skin turgor hypovolemia –  Decreased BP problem in TPR? CO? BV? –  OrthostaIc hypotension hypovolemia Preliminary Diagnosis •  Addison’s Disease Lab Tests •  •  •  •  •  •  •  •  CorIsol decreased (adrenal cortex) Aldosterone decreased (adrenal cortex) ACTH increased Hyperkalemia related to aldosterone? Hypoglycemia related to corIsol? Hyponatremia related to aldosterone? Increased ADH secondary to hypovolemia Metabolic acidosis related to aldosterone, aka type IV renal tubular acidosis ACTH sImulaIon test (negaIve) Test Na+ K+ Osmolarity CorIsol Aldosterone ACTH pH HCO3 ­ Value 126 mEq/L 5.7 mEq/L 265 mOsm/L Decreased Decreased Increased 7.32 18 mEq/L Glucose (fasIng) 50 mg/dl Diagnosis •  Addison’s Disease (primary adrenocorIcal insufficiency) Treatment •  Hormone replacement –  HydrocorIsone or prednisolone to replace corIsol funcIon –  FludrocorIsone to replace aldosterone funcIon Prognosis •  With proper treatment, paIents can expect to live a healthy and normal life Physiological IntegraIon •  Causes of adrenal insufficiency –  Adrenal dysgenesis –  Impaired steroidogenesis –  Adrenal destrucIon •  AdrenocorIcal insufficiency results in adrenal cortex not being able to secrete… –  CorIsol –  Aldosterone –  Adrenal androgens DHEA and androstenedione Physiological IntegraIon •  GlucocorIcoids •  MineralocorIcoids •  DHEA, androstenedione Physiological IntegraIon •  Decreased levels of cor7sol, aldosterone, adrenal androgens Physiological IntegraIon •  Decreased corIsol –  FasIng hypoglycemia –  Lowered BP (corIsol upregulates alpha1 ­ adrenergic receptors on vascular smooth muscle) –  Extreme faIgue –  Very thin, weight loss Physiological IntegraIon •  Decreased aldosterone –  Hyperkalemia –  Hyponatremia (also secondary to reduced BV) –  Metabolic acidosis –  Decreased BV •  Lower BP •  OrthostaIc hypotension •  Decreased skin turgor Physiological IntegraIon •  Decreased adrenal androgens –  Decreased body hair in pubic and axillary regions Physiological IntegraIon •  NegaIve ACTH sImulaIon test (disInguishes primary from secondary adrenocorIcal insufficiency) Physiological IntegraIon ...
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