A 43-year-old female presented with a 15 month history of weight gain, hirsuitism, weakness that had increased over time, and oligomenorrhea.

A 43-year-old female presented with a 15 month history of weight gain, hirsuitism, weakness that had increased over time, and oligomenorrhea. Her blood pressure was 175/105 mm Hg.
Laboratory Data
Sodium                  153 mmol/L
Potassium             2.7 mmol/L
Chloride                 107 mmol/L
Bicarbonate           34 mmol/L
Glucose                 118 mg/dL

The physician ordered an 8:00 a.m. and 4:00 p.m. plasma cortisol. The 8:00 a.m. value was 22 g/dL and the 4:00 p.m. value was 24 g/dL.
1.    The laboratory results are most indicative of which of the following disease states? Defend your answer. Also, state why the other disease states CANNOT be the causative agent.
a.    Addison’s disease
b.    Adrenogenital syndrome
c.    Cushing’s syndrome
d.    Conn’s syndrome

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2.    What two screening tests are recommended for detecting Cushing’s Syndrome? How are they useful in the diagnosis?

3.    Explain the sodium and potassium levels based on the diagnosis of this patient.

4.   What are the hormones involved, the primary symptoms, and the lab tests used to aid in the diagnosis of the following conditions?
Addison’s disease
Hyperaldosteronism
Adrenogenital syndrome

5.    How are plasma ACTH levels useful in the differential diagnosis of Cushing’s Syndrome?
Task 2:
A 50-year-old female complains of excessive sweating and heart palpitations. On physical examination, her skin is warm and moist, pulse 120/minute, and blood pressure 150/95 mm Hg. She has noticed excessive watering and a foreign body sensation in her eyes. A blood test for thyroid function yields the following results.
Free T4 = 3.20 ng/dL
TSH = <0.03 U/mL
1.    Based on the results provided, how would you assess the patient’s thyroid function?
2.   What are three common causes of hyperthyroidism?
3.   What would be the next step in thyroid testing to further pinpoint the cause of the patient’s symptoms? Explain your reasoning.
4.   The patient tests positive for TRAb. Based on these results, what would be the patient’s diagnosis? Explain the pathophysiology of this disease.
5.   What would be the expected results of the following tests in this case?
a.    T4
b.    T3
6.   Suggest three treatment strategies for hyperthyroidism.
7.   Suggest an explanation for the low TSH value.
8.   What is a major function of thyroid hormones?
9.   What laboratory test(s) would best differentiate primary and secondary hyperthyroidism?
10. What is the formula for calculating free thyroxin index? What is its diagnostic utility in diagnosing thyroid disorders?
11. What screening tests for congenital hypothyroidism are commonly performed?

Answers:

Task 1:

1. The laboratory results of the 43-year-old woman indicate a case of Cushing’s disease. All of her symptoms point towards this disease. Her history of weight gain, hirsuitism, increased weakness, oligomenorrhea; high blood pressure and increased plasma cortisol are the symptoms of this disease (Melmed et al., 2015).

Addison’s disease cannot be the causative agent because the primary symptoms of the disease are low blood pressure and insufficient production of steroid hormones.

Adrenogenital syndrome is a congenital disease; thus, it cannot initiate in a 43-year-old woman, and Conn’s syndrome is not the causative agent because it is the hyper-production of aldosterone hormone which lowers the renin le………………………………