A 45-year old male from the Midwest presented with the following symptoms during

Question

A 45-year old male from the Midwest presented with the following symptoms during February: weakness, fatigue, orthostatic hypotension, weight loss, dehydration, and decrease cold tolerance. His blood chemistry values follow: Serum sodium 128 mEq/L normal 136-139 Serum potassium 6.3 mEq/L normal 3.5-5.0 Fasting blood glucose 65 mg/dL normal 70-110 Hematocrit: 50 % Leukocytes: 5,000 mm3 He also noticed increased pigmentation (tanning) of both exposed and nonexposed portions of this body and back. A plasma cortisol determination indicated a low cortisol level. Following administration of ACTH, plasma cortisol did not rise significantly after sixty to ninety minutes. Endogenous circulating levels of ACTH were later determined to significantly elevated.

1. what is orthostatic hypotension?

2. what hormone from which organ is most likely involved with his serum electrolyte imbalance?

3. is he anemic? which of the test results answer this question?

4. does he have an infection? which of the test results answers this question?

5. which hormone is most likely associated with the symptoms of weakness, fatigue, weight loss and decreased cold tolerance?

6.a. what endocrine organ is the site of the malfunction?

6.b. what hormones are normally secreted from this gland?

6.c. is more than one hormone deficient in him?

7.a. how is it possible for his plasma glucose to be within the normal range?

7.b. what is the name of his disorder?

8. in a normal person how would plasma cortisol levels be affected following administration of ACTH? what do his ACTH test results imply?

9. is this a primary or secondary disturbance? explain your answer.

10. why is his endogenous circulating level of ACTH significantly elevated?

11.a. what is the cause of his hyperpigmentation?

11.b. how is hyperpigmentation related to his high levels of ACTH?

12. what type of replacement therapy would be required for him? will the replacement of one hormone suffice to treat all his symptoms?

13. diagram the feedback loops for this endocrine disorder.

14. what is the long-term outlook for him? might one expect his abnormal pigmentation to resolve one his treatment has begun? explain.

Explanation / Answer

1. Orthostatic Hypotension - also called as Postural Hypotension is decrease in systolic blood pressure more than 20 mm Hg or diastolic bp more than 10 mm Hg while standing for some minutes (3 minutes) as compared to sitting or lying. (Normal BP 120/80).

2. Mineralocortocoid - a cortoco hormon responsible for electrolyte balance in the body. Gland - Adrenal gland.

3. No as his Hematocrit is 50% which is normal for adult male ( Normal 45-52% in male). Hematocrit is ratio of RBC to blood volume. Its increase indicate anemia. Other investigation may be required.

4. No. Leukocyte counts are normal 5,000 (normal 4,000 - 11,000). Increase in leukocyte count indicat infection.

5. Glucocortocoid.

6a. Adrenal gland.

6b. Mineralocortocoid and Glucocortacoid.

6c. Yes both Glucocortacoid and Mineralocortocoid.

7a. Glucose is not normal, he is Hypoglycemic as norlal is 70-100 mg/dl and his glucose is 65mg/dl.

7b. Addision's Disease.

8. Plasma cortisol will increase after administration of ACTH. High ACTH level imply that pitutary is normal and the problem lies within adrenal gland itself.

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