CASE 1. Radomiro Goicoechea Mr. Radomiro Goicoechea had been feeling tired and w

Question

CASE 1. Radomiro Goicoechea
Mr. Radomiro Goicoechea had been feeling tired and weak and suffered several falls without any apparent external cause. His primary physician first referred him to be evaluated by a neurologist. After multiple physical and lab exams, the neurologist referred him to an endocrinologist since Radomiro presented an abnormal thyroid panel in the clinical lab tests; he noted that the level of thyroid stimulating hormone (TSH) was abnormally elevated, while his thyroxine (T4) level was abnormally low. To complicate matters, Radomiro’s sodium ion level was low and his serum potassium ion level was elevated and he was also slightly hypoglycemic. The endocrinologist he was referred to examined Radomiro and noticed he had orthostatic hypotension. Given these complications, he wondered whether Radomiro might have problems with his adrenal gland. He ordered several additional blood tests for serum cortisol level and serum adrenocorticotropic hormone (ACTH) level.

ANSWER THE FOLLOWING QUESTIONS. Each answer must not exceed 50 words Mr. Goicoechea was evaluated by a neurologist who referred him to an endocrinologist. Describe, in general terms, the main differences between the nervous and endocrine systems.

1. The results of Radomiro’s thyroid function indicate that he has hypothyroidism. Discuss the normal negative feedback loop that regulates thyroid hormone release, starting with the hypothalamus

Briefly describe how the thyroid gland responds to TSH

Suppose (although this is not the case) that Radomiro’s levels of TSH and

T4 were both abnormally low, considering the normal negative feedback loop, what possible abnormalities could lead to these results?

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4. The endocrinologist suspects that Radomiro has developed adrenal insufficiency based on the preliminary lab findings. What hormone secreted by the adrenal glands would affect sodium and potassium levels, and what is happening in Radomiro’s case?

5. The endocrinologist also ordered tests for serum cortisol. How may cortisol be associated with hypoglycemia during episodes of stress?

Explanation / Answer

1. Difference between nervous system and endocrine system is nervous system is complex network of nerves and cells that are responsible for carrying message to and from the brain to spinal cord and then to the other parts of the body. Endocrine system is collection of glands that secretes hormones directly into the blood circulation and carried to the target organs where they reguales the activity of cells and organs.

2. Normal negative feedback of thyriod hormones

When their is low level of thyriod hormones in the blood then the hypothalamus acativates and release thyrotropin releasing hormones (TRH) which stimulates the pituitary glands for the released of thyriod stimulating hormones (TSH). TSH stimulates thyriod glands for the release of thyriod hormones which continue to produce untill the level become normal. Then thyriod hormone exerts negative feed back to control hypothalamus and pituitary gland which in turn control the release of thyriod hormones.

3. As the pituitary gland stimulates the release of TSH, this in turn stimulates the thyriod gland for release of thyriod hormones (T3 & T4)

Levels of both TSH and T4 is abnormally low, as low levels of TSH leads to hyperthyriodism but this also associated with the abnormalities of the pituitary gland.

4. Aldosterone hormone which is mineralocorticoids hormone is responsible for the affect of sodium and potassium level in body. In case of radomiro, their is deficiency of aldosterone hormone ie addition disease which causes excretion of more sodium ion and retention of potassium ion.

5. Cortisol hormones are main hormone for stress and fight or flight response in body. When their is hypoglycemia condition arises in body, then the cortisol level is increase in body which is responsible for the gluconeogensis in liver which in turns increase the blood glucose level.

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