module 9 case study Flashcards
If T4 and T3 levels are found to be elevated, while TSH levels are found to be low, is this a primary or secondary endocrine disorder? Explain your answer.
It would be considered a primary endocrine disorder because the problem roots within the target gland (thyroid gland) producing excess hormone (T4 and T3). The thyroid (the problem) is making too much of the hormone making it a primary endocrine disorder (does not have to do with the pituitary gland). The lowered level of TSH should result in less production/secretion of T3 and T4. Since these are still elevated, the problem must lie with the thyroid gland, itself.
Would the same conclusion as to the type of disorder be reached if an analysis for the presence of TSI (thyroid stimulating immunoglobulin) turned out to be positive? What disease would be indicated in this case?
if the presence of TSI turned positive. The disease indicated would be Grave’s Disease. The conclusion would be the SAME. TSI = Grave’s disease meaning it is STILL a primary endocrine disorder. TSI is the antibody that is produced in Grave’s disease that mimics the action of TSH.
indicate which manifestations in the case above support your diagnosis of the disease in question 2.
- Weight loss
- Bad mood
- Dizziness
- Increased blurring of vision (the blurring of vision would be caused by exophthalmos = due to hyperthyroidism) Exophthalmos is specific to Graves disease and is a build up of the soft tissue behind the eyes that causes them to protrude.
- Heart Arrhythmia
Describe the pathophysiology behind the disease diagnosed in question 2.
Antibodies that have been produced against TSH receptors on thyroid gland cells (type II hypersensitivity reaction) result in stimulation of thyroid hormone production, which will then cause the excess production of thyroid hormone. TSI = an antibody that is produced against the TSH receptors on the thyroid gland, so it mimics TSH»_space; increase production of T3 and T4.
On the other hand, if the TSH levels are found to be high (with no TSI detected), identify where the problem most likely is and explain your answer. Identify a possible cause. Would this be a primary or secondary disorder?
If the TSH levels are found to be high along with elevated T3 & T4 levels, then the problem lies within release/inhibiting hormones of the pituitary gland. TSH is being constantly released/not inhibited, so the thyroid gland is constantly being stimulated to produce more T3 and T4. A possible cause can be TSH secreting pituitary adenoma. This would be considered a secondary endocrine disorder.
If the situation in question 5 is true, what might be an explanation of the problems K.L. is experiencing with her vision?
With a growing benign tumor (the pituitary adenoma), it can put pressure on other critical structures in the brain. In the case of K.L., her explained loss of vision can be due to pressure being applied to the optic nerves in the brain from the pituitary adenoma since the pituitary gland and optic nerves are relatively near each other in the brain. (The optic chiasm lies directly above the pituitary gland).
if the situation in question 5 is true, explain how K.L. may be at risk for decreasing secretion of anterior pituitary hormones other than TSH.
K.L. is at risk of other hormonal secretion problems because the pituitary gland can be seen as the “main controller of all glands.” If there is a problem with the secretion of pituitary gland hormones, it can cause stimulation of other hormonal glands to start production of their own hormones, causing problems/manifestations of other hormonal problems, other than hyperthyroidism. The pressure of the tumor can cause suppression of other hormones if its adding pressure on the hormone producing cells. (This is because the pituitary gland sits in a small bone cup that cannot expand, so any growth in a particular area within the gland will put physical and metabolic pressure on the cells around the tumour). You can get hypersecretion of one hormone from a tumour that causes hyposecretion of hormones released by the surrounding cells within the gland).
What is the most likely systemic condition that Alice Jones is suffering from? Support your conclusion with manifestations shown by Alice.
The condition Alice is most likely suffering from is Type II diabetes. She has pruritus felt in her feet, she is showing prehypertension, bruit was auscultated over her right carotid artery, the skin of the back her hand does not recover right away and her mucous membranes are dry (sign of dehydration), increased need to urinate (= polyuria), increased water consumption (very thirsty) [= polydipsia], numerous yeast infections, and high A1C (HBA1c) test percentage (8%). Just a small correction (not important for this case: pruritis is itching, paresthesia is tingling)
Describe the steps in the development of Alice’s systemic condition
- Insulin resistance occurs
- Compensatory hyperinsulinemia results and prevents significant hyperglycemia and its effects. However, there may still be lower levels of hyperglycemia, as the beta cells of the pancreas cannot make enough insulin to completely control glucose levels.
- Beta-cell dysfunction will develop and will lead to both a decrease in the number of beta-cells and a reduction of normal beta-cell function. The remaining cells undergo “exhaustion” from increased demand for insulin biosynthesis.
- The decrease in insulin production leads to significant hyperglycemia, due to intake of glucose with meals, and due to increased glucose production by the liver, which is usually depressed by insulin.
What are the risk factors for the above condition in this case?
Old-ish age (51)
Pre-hypertension blood pressure (130/85)
Overweight
Suffered gestational diabetes during her second pregnancy
What is the significance of pinching the skin on the back of the hand and seeing how long it takes to recover?
It is due to dehydration. With polyuria and glycosuria (osmotic pressure), from diabetes, you lose a lot more urine which leads to dehydration. If the skin takes long to recover, it means you are dehydrated
Which of her vital signs should cause the most immediate concern? How is this related to the observation of a bruit (google what this is) over her right carotid artery? For what extremely serious event is she at risk (consider the location of the bruit)?
A vital sign that should be most immediate concern is her high blood pressure. A bruit is the sound of turbulent blood flow; the blood flow through an artery must be moved through a laminate flow (= blood vessel should be “flat”) all in one direction smoothly. If you have a bruit, it means you have turbulence = something sticking out in the blood vessel. Atherosclerosis plaque produces a bruit. The problem if the bruit was over her right carotid artery means that an atherosclerosis plaque is developing there, and all you need is a clot (thrombus/embolus) to stop blood flow from reaching to the brain which will result in a strok
What does the A1C value represent (google this)? How is this related to Alice’s condition?
The A1C value represents/measures the amount glucose that is permanently bound to the protein hemoglobin molecule (glycation). The reason the value is an average of 2-3 months is because RBC’s have a lifespan of 2-3 months before they die. What is occurring with Alice’s condition to produce the elevated value (8%) is the chronic complication of diabetes mellitus (chronic hyperglycemia = an excess of glucose in the blood stream). (Every time she has a hyperglycemic event, she is going to have glucose attach to her hemoglobin). It shows the average of her whole blood glucose over 2-3 months.
Explain the pathophysiology behind the tingling in Alice’s feet.
Tissues that do not require insulin to import glucose cannot decrease the uptake of the glucose. The excess glucose is converted to sorbitol which is osmotically active. The buildup of sorbitol damages schwann cells producing neuropathies.»_space;> due to the metabolic factors (buildup of sorbitol in neurons), sensory deficits occur in the extremities. This loss of sensation occurs at the toes and fingers often (aka sock and glove syndrome) [pruritus]. Also due to ischemia. (pretty much due to ischemia and sorbitol buildup).
Explain a connection between her present condition and an increase in yeast infections.
With the increased blood sugar levels (which eventually leads to increased sugar in the tissues), it can be beneficial for pathogen growth, in this case the yeast cells in the vaginal area. The yeast cells colonized the vaginal spaces and overtook the normal flora with the increased glucose in the body fluids. (Also decreases immune response)
