Week 5 Endocrine Case Studies Monday by Mélanie Filion

what is Addisons disease? what hormones are affected? what are possible causes?

2019-02-04 14:46:48 UTC

Addisons disease is a primary adrenal insufficiency and hypocorticolism. adrenal glands aren't producing enough steroid hormones and adrenal corticoids. the cause is due to adrenal insufficiency glands not producing enough cortisol.

2019-02-04 14:47:43 UTC

What is the difference between Cushing Disease and Cushing Syndrome?
Syndrome: refers to clinical manifestations resulting from chronic exposure to excess cortisol regardless of cause
Disease: refers to endogenous secretion of ACTH

What are the hormones affected? What are the possible causes?
The hormone affected in this disease is ACTH and cortisol
It is an excess of ACTH because the normal circadian rhythms are lost and there is loss of feedback mechanisms.
Occurs more often in women
Syndrome is thought to be linked with long-term use of glucocorticoids
Some tumours

Whats happening in the body?
The normal diurnal rhythm or circadian patterns of ACTH and cortisol are lost
There is no increase in ACTH and cortisol in response to stress

Identify and explain the common manifestations?

Weight gain: results from the accumulation of adipose tissue in the trunk, facial and cervical areas
Glucose intolerance: cortisol induced insulin resistance and increased gluconeogenesis and glycogen storage
Protein wasting: catabolic effects of cortisol on peripheral tissues
Hypertension: increased vascular sensitivity due to elevated cortisol levels
Thin, weak skin: loss of collagen, purple Striae
Irritability, decreased concentration
Increased hair growth

What would you expect the lab results to look like if the patient has Cushing's?
Elevated cortisol
CBC and Differential (may show high WBC and increased neutrophils)
Glucose tolerance test (Impaired)
Potassium (decreased)
What are the potential complications?

Bone loss
Hypertension
Type 2 diabetes

1. What is diabetes mellitus? what hormones are affected?

2019-02-04 14:47:50 UTC

Diabetes Mellitus - the production and response to insulin hormone is impaired. This causes an abnormal metabolism of carbs, glucose elevation in urine and blood. Type 1 DM (hormones affected): loss of beta cells, insulin, amylin
Type 2 DM (Hormones affected):

What is Addisons's Disease?

2019-02-04 14:47:57 UTC

Adrenal Insufficiency

What are the hormones affected?

2019-02-04 14:48:25 UTC

Low levels of cortisol

7. Explain why Ms. R has bulging eyes

2019-02-04 14:48:38 UTC

Buildup of carbohydrates in tissues and muscles behind the eyes. (The same antibody that causes thyroid dysfunction is attracted to tissues around the eyes)

8. What does Ms. R.'s tight collars and neck mass suggest?

2019-02-04 14:48:58 UTC

Enlargement of thyroid gland, goiter

What are the possible causes?

2019-02-04 14:48:59 UTC

Autoimmune destruction of adrenal cortex

What's happening in the body?

2019-02-04 14:49:12 UTC

Gradual destruction of the adrenal cortex

9. Explain "Thyroid storm" or thyrotoxicosis

2019-02-04 14:49:16 UTC

A complication of untreated hyperthyroidism, Increase in BP, heart rate, and temp (V Dangerous)

1. Hypothyroidism: low activity of the thyroid gland. (TSH, T4, T3)

2019-02-04 14:49:56 UTC

Hashimotos: (autoimmune) immune system attacks the thyroid
Hormones: T3 and T4
Causes: Genetic/environmental.

Explain the manifestations

2019-02-04 14:51:29 UTC

Low cortisol and aldosterone
Hyperpigmentation
Low BP
F/E imbalance

What would you expect the lab results to look like?

2019-02-04 14:51:59 UTC

Low sodium and low cortisol

What are potential complications?

2019-02-04 14:52:43 UTC

Hypotension, tachycardia, dehydration, hyponatremia, N/V, diarrhea, confusion, fever, weakness, hypoglycemia

2. primary disorder affecting the thyroid gland. normal TSH, low levels of T3 and T4. Increased thyroid antibodies that block TSH receptors.

2019-02-04 14:53:19 UTC

3.

2019-02-04 14:55:37 UTC

Weakness
Fatigue
Weight gain
Cold intolerance
Swollen thyroid
Bradycardia
High cholesterol
Dry skin

4. Primary Disorder, AP working

2019-02-04 14:57:08 UTC

2. Compare and contrast type 1 and type 2 diabetes mellitus? include age of onset and whats happening in the body in your discussion. what are possible causes?

2019-02-04 14:57:16 UTC

Type 1 DM - Beta cell destruction, usually leading to absolute insulin deficiency. The age of onset usually occurs in youth. As a result of the body being unable to produce insulin, which moves glucose out of the blood and into your cells to be used for energy. without insulin, your body will break down its own fat and muscle, resulting in weight loss. The exact cause of type 1 diabetes is unknown. usually the body's own immune system which normally fights harmful bacteria and viruses - mistakenly destroys the insulin producing, (islets, or islets of langerhans) cells in the pancreas.
Type 2 DM - Insulin resistance. develops when the body becomes resistant to insulin or when the pancreas is unable to produce enough insulin (usually occurs in middle age adults). can cause high blood sugar levels in different ways. type 2 diabetes, the pancreas still makes insulin, but the insulin doesn't do its job as well in the body, glucose just hangs around and builds up in the blood. Possible causes - genetics and environmental factors such as being overweight, being inactive.

5.

2019-02-04 14:57:52 UTC

Anemia
Thyroid deficiency
Metabolism

other autoimmune disorders:

2019-02-04 14:58:49 UTC

- Vitamin B12 deficiency
- Celiac disease
- Low cortisol levels
- Type 1 diabetes
- High cholesterol, increases LDL (cardiomegaly)
- myexedema coma

3. Considering D.K.'s Presenting history and physical data, what form of diabetes mellitus is indicated?

2019-02-04 15:07:41 UTC

Type 1 diabetes mellitus- given the signs of weight loss, hyperglycemia, fatigue, age 35 years old. constant try - increase in thirst

4. Explain the manifestations?

2019-02-04 15:09:34 UTC

- Polydipsia
- Polyuria
- polyphagia
- weight loss
- fatigue

6. D.K. needs to understand the signs and symptoms of hypoglycemia so that she can quickly intervene to prevent life-threatening complications. how can she recognize hypoglycemia and what should she do when it occurs.

2019-02-04 15:10:44 UTC

She can recognize hypoglycemia by checking her blood sugar levels. some signs and symptoms of hypoglycemia are:
Mild - hunger, nervousness and shaking, sweating.
Moderate - dizziness, sleepiness, confusion, difficulty speaking, feeling anxious or weak.
Severe - seizure or convulsion, loss of consciousness or coma.

5. What are potential acute complications? compare and contrast diabetic ketoacidosis and non-hyperosmolar

2019-02-04 15:16:31 UTC

DK - life threatning problem that can affect people with diabetes. this occurs when the body starts breaking down fat at a rate fat at a rate that is to fast. this can cause ketones in urine and causes blood to become acidic
Non-hyperosmolar - is a state of metabolic complications of diabetes mellitus, caused by extreme amounts of hyperglycemia, extreme dehydration

7. What immediate and long-term therapy will D.K need to manage her disorder?

2019-02-04 15:17:39 UTC

Needing to use insulin,, frequent blood sugar checking.

8. D.K must frequently monitor her own glucose levels to evaluate her diabetic control. what range of blood glucose should be advised to aim for?

2019-02-04 15:18:09 UTC

glucose range is 3.6-6.9mmol/L

9. D.K's health care provider plans to routinely monitor glycosylated hemoglobin levels (HbA1c). what information can be gained fro this laboratory test.

2019-02-04 15:19:12 UTC

This test is critically dependent upon the method of measurement and must be related to established standards. 2-3 months

10. D.K. should be aware of the potential acute and long-term complications of diabetes mellitus. what are they?

2019-02-04 15:20:20 UTC

Over tie, high blood glucose levels can damage the body's organs. possible complications include damage to large (macrovascular) e.g. is retinopathy. and small microvascular such as cardiac, stroke blood vessels, which can lead to heart attack, stroke, and problems with the kidneys, eyes, gums, feet and nerves. also your at a increased risk for infections. if infection present its harder to treat slower process time, needs to be treated.