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PATHOPHYSIOLOGY – Endocrine system – Case studies Case study:…
PATHOPHYSIOLOGY – Endocrine system – Case studies
Case study: Endocrine
Scenario 1:
A 30-year-old woman, Jocelyn, presented to the clinic with development of acne, weight gain,
and back pain for the past 3 months. She has also noticed some muscle weakness with
difficulty lifting her 2-year-old daughter. As well, she has become aware of purple streaks on
her abdomen.
Upon further questioning, she stated that she also noticed ? urination and ? thirst.
VS: BP: 170/110 HR: 80 Temp: 37ºC O2Sat: 99%
LABS: CBC – Normal
Electrolytes – Normal
Serum glucose- 325 mg/dL
1) From what possible illness is she suffering? (SLIDES 25-30)
2) Discuss 3 possible ways to develop this syndrome. Which is the most common? (SLIDE 25
3) Review the signs and symptoms of this illness. (SLIDES 26-30)
4) When administering corticosteroids for weeks to months, why, when the patient is ready
to stop the corticosteroids, is it critical to slowly taper patients off the medication? (SLIDE
32)
5) Which hormones are secreted by the adrenal cortex? (SLIDES 17, 24)
Scenario 2:
A 45-year-old woman, Charice, presents with nausea, vomiting, and loss of appetite. She has
been complaining of dizziness with standing and profound weakness. She has also noticed a
bronze discoloration to her skin recently.
VS: BP: 90/60 HR: 95 Temp: 37ºC O2Sat: 99%
LABS: CBC – Normal
Electrolytes – Na+ : 128 meq/L
K+ : 5.8 meq/L
Cl : 104 meq/L
Ca : 9.5 mg/dL
1. What possible endocrine condition may be occurring? (SLIDES 32-33)
2. What is the pathophysiology of this condition? (SLIDE 32)
3. Review the symptoms and signs of this disease. What is the pathophysiology of Charise’s
skin discoloration? (SLIDE 35)
4. What would the treatment likely consist of for this disease? (SLIDE 36)
5. What is primary vs. secondary Addison’s disease? (SLIDE 33)
6. Discuss the 2 possible mechanisms for developing this illness. (SLIDE 32)
7. Discuss ‘Addisonian Crisis’ in relation to use of glucocorticoids. (SLIDE 32)
Scenario 3:
A young man, Armen, describes a variety of intermittent symptoms over the past 6 months.
He states “I’ve been sweaty, anxious, and having tremors. These have happened while I have
been developing severe headaches”.
VS: BP: 185/120 HR: 110 Temp: 37ºC O2Sat: 98%
LABS: CBC – Normal
Electrolytes – Normal
Urine Catecholamines – elevated
1) Discuss the most likely condition associated with these symptoms. (SLIDE 38)
2) Discuss the pathophysiology of this disease.
3) Describe the common symptoms associated with this disease.
4) Briefly discuss the potential treatment of this condition.
Scenario 4:
A young female, Liling, has been feeling fatigued, and depressed with excessive weight gain.
She stated that she often “feels cold” and has been losing hair rapidly, with associated dry skin
and brittle nails. She has been trying to get pregnant for the past year without any success.
1) Which endocrine disorder may be causing her symptoms? (SLIDE 40)
2) Discuss the pathophysiology of the disorder. What is the most common cause? (SLIDES
44-45)
3) Review the common symptoms and signs of this disease. (SLIDE 46)
4) Which hormone is deficient? Discuss how TSH may differ in primary and secondary
hypothyroidism. (SLIDES 44, 49))
5) Discuss the term “goiter”. How does it develop? (SLIDE 42)
6) How is this condition treated and monitored? (SLIDE 49)
Scenario 5:
A university student, Binita, visits the campus health care clinic with an assortment of
symptoms that have been developing since starting the school semester.
She describes a racing heart that feels irregular, significant weight loss, and feeling anxious and
sweaty most days. Her roommate has been complaining to Binita because she seems irritable
and has been frequently turning down the heat in the apartment. Binita attributes her
symptoms to school stress.
ON EXAM: She appears anxious and hyperactive with glaring eyes. Her thyroid gland is
palpable in her anterior neck and a fine hand tremor is noticed.
VS: BP: 120/80 HR: 120 Temp: 37ºC O2Sat: 98%
LABS: CBC – Normal
Electrolytes – Normal
TSH – Low
T4 (thyroxin) — elevated
1) Discuss the most likely diagnosis. What symptoms and signs does she have that suggest
this disease? What other S/S may develop? (SLIDES 50, 53)
2) Discuss the common causes of hyperthyroidism. What is the pathophysiology? (SLIDES 51-
52, 54)
3) How is it diagnosed in a patient? (SLIDE 57)
4) Briefly discuss the treatment of this disease. Why may the patient require thyroid
hormone (T4) replacement? (SLIDE 59)
5) Discuss the expected lab values of T4/T3 and TSH in Grave’s disease.
Binita has a thyroidectomy for Grave’s disease since medications were ineffective. Following
surgery, Binita develops muscle cramps, carpopedal spasms, and numbness to her lips.
1) What does the endocrine team suspect has occurred? (SLIDE 63)
2) Explain the pathophysiology that results in her symptoms. (SLIDES 63-64)
3) Review Trousseau and Chvostek signs of hypocalcemia. (SLIDE 64)
4) Review other common symptoms of hypocalcemia. (SLIDE 66)
Case 6:
A 38-year-old man presents with painful joints to his hands, feet and knees. He
attributes his painful joints to always having a weight issue. Over the past few
years, he has come to notice that his hands and feet have enlarged, requiring
larger shoes and gloves. In the past 6 months he’s also developed daily headaches
and feels his vision has diminished.
1) Discuss his most likely condition. What is the most common cause of this
disease? (SLIDES 2-6)
2) Review the importance of growth hormone in the body. What are the
conditions plus the symptoms/signs of excessive growth hormone as a child and
as an adult? (SLIDES 4-5)
3) How is Gigantism or Acromegaly treated? (SLIDES 5-6)
4) Discuss what occurs with deficient growth hormone as a child. (SLIDE 4)
Case 7:
A 12-year-old healthy boy is brought to the hospital by his concerned parents.
Over the past 3 days he has become very ill-appearing to them. He’s complaining
of nausea, vomiting and abdominal pain associated with significant weakness and
15-pound weight loss. He has been very thirsty and hungry but is unable to keep
any fluids down due to the vomiting but is still urinating a lot. As well he’s noticed
blurry vision since yesterday.
Exam: looks ill, lethargic, very dry lips and mucous membranes
VS: BP-70/50, HR- 125 O2sat-98% RR-30/min Temp- 37c
CBC: Normal except Hg is 18.5 g/dL.
Electrolytes: Na- 152 meq/L, K- 5.9 meq/L, Cl- 102 meq/L
Serum Glucose: 415 mg/dL (normal 70-120)
Urinalysis: glycosuria (normal is none)
ABG: pH 6.9 (normal 7.35-7.45)
1) Discuss normal serum glucose levels and its regulation with insulin and
glucagon. How is insulin secreted throughout the day into the bloodstream?
(SLIDES 15-17)
2) Discuss the functions of insulin in the body. (SLIDES 16-19)
3) What is the pathophysiology of this illness? What is causing him to be so ill?
(SLIDE 20)
4) Review the common signs/symptoms with the onset of Type 1 diabetes
5) Discuss in further detail the cause of diabetic ketoacidosis in Type 1 diabetes,
why does it make patients critically ill?
6) Briefly discuss the treatment of Type 1 diabetes, what is the goal of this
treatment? What is the potential serious adverse effect while using this
medication?(SLIDE 22)
7) Explain the use of HgA1c testing in any diabetic patient. (SLIDE 24)
Case 8:
A 72-year-old woman complains of an ongoing cough for 3 months associated
with hemoptysis. She has a 40-year history of heavy smoking. Upon presentation
to the clinic, she feels weak, nauseated and has developed headaches that don’t
resolve with acetaminophen use.
Vital signs: HR-90, BP-155/90, O2sat- 98% and Temp 37.0c
Bloodwork:
CBC- Normal
Electrolytes- Na- 126 meq/L, K- 3.8 meq/L, Cl- 102 meq/L
Urinalysis- dark concentrated with high specific gravity
1) What is her potential abnormal hormonal condition, and the pathophysiology
causing it? What are the causes? Explain the abnormal urinalysis and electrolyte results. (SLIDES 7, 9, 12)
2) Discuss the signs and symptoms associated with this disorder. (SLIDE 12)
2) What could be the treatment for this condition?
Case 9:
Gerald, a 62-year-old overweight man has developed the gradual onset of fatigue,
weakness, polyuria, polydipsia and blurry vision. He admits to being physically
inactive and having a diet high in simple carbohydrates such as pop and desserts.
Over the past 2 years he has gained an additional 30 pounds related to his diet
and lack of regular exercise. He continues working at his office job but is finding it
increasingly difficult with fatigue and blurry vision.
Hi PCP sends him for routine blood tests and urinalysis prior to seeing him in the
office.
At the office appointment:
VS: Temp. 36.5, BP-177/95, HR-90/min and regular, O2sat-97%
Blood and urine testing:
CBC: normal, Electrolytes: normal, TSH- normal, Cortisol- normal
Serum glucose- 298 mg/dL, Urinalysis- glycosuria
1) Discuss Gerald’s condition of Type 2 diabetes, discuss his
symptoms/signs/labs that likely relate to his illness. (SLIDES 25-27)
2) Discuss the pathophysiology of Type 2 diabetes, what are the major risk
factors for developing this disease. (SLIDES 28-29)
3) How does Type 2 diabetes significantly differ from Type 1 diabetes? Why do
patients with Type 2 diabetics rarely if ever develop “ketoacidosis”?
4) Discuss the complication of having Type 2 diabetes called “Hyperosmolar
hyperglycemic state”. What is the pathophysiology of this complication, and its
symptoms/signs? (SLIDE 27)
5) Discuss the term “Gestational Diabetes”. Which type of diabetes is it very
similar to in its pathophysiology? How is gestational diabetes treated? And what
is the risk to the fetus/mother? What condition is the mother at higher risk of
developing in the future. (SLIDE 28)
6) Review the long-term complications from either type of diabetes considering
damage to microvascular and macrovascular arterial vessels. (SLIDES 29-31)
