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Courtney Takahashi, Dean Fraser, Carrie Marshall, Hazel Abinsay, Mark Valdez, Shauna Conry

Endocrine Mystery Cases


27 April 2006

1. Distubance 4, bitemporal hemianopsia

2. Increased pigmentation, decreased levels of adrenal glucocorticoids and


mineralocorticoids, what condition is he suffering from?
Answer: A, primary adrenocortical insufficiency (Addison’s disease)
• In Addison’s disease, there are increased levels of ACTH. ACTH contains a MSH-α
fragment, which increases pigmentation
• The treatment for Addison’s disease is the administration of glucocorticoids and
mineralocorticoids since the destroyed adrenal cortex can no longer produce them

3. Patient X suffering from galactorrhea, secondary to excessive prolactin levels


Answer: C is the thyroid
Hypothalamus

Dopamine (-) TRH (+)

Anterior Pituitary

Prolactin (High)

Breast

4. Haane has to use the bathroom constantly. Blood and urine samples were taken and gave
the following results:
• Plasma osmolarity: increased
• Urine osmolarity: decreased
• Urine osmolarity after water deprivation: no change
• Plasma ADH: high
Haane’s laboratory results are consistent with nephrogenic diabetes insipidus. Her kidneys are
unresponsive to ADH.
• Her plasma osmolarity is increased because she is excreting excess water in her urine
which concentrates her plasma
• Her urine osmolarity is decreased even after water deprivation (which normally would
concentrate the urine) because her kidneys are unresponsive to ADH and therefore cannot
concentrate urine.
• Her plasma ADH is high because her high plasma osmolarity stimulates the posterior
pituitary to secrete ADH despite the unresponsive nature of her kidneys.
5. Millie’s neural stalk was severed during surgery. She soon notices a milky discharge
from her nipples.

1
Hypothalamus

Dopamine (-)

Anterior Pituitary

Prolactin

Breast
The production of milk is a positive feedback loop is inhibited by dopamine. If Millie’s neural
stalk was injured, then she no longer has the dopamine suppression of milk production; hence the
discharge from her nipples.

6. If a person was given glucocorticoid drugs, which zones of the adrenal gland would
atrophy?
Zona fasciculata and zona reticularis.
The thicker middle zona fasciculata and the compact innermost zona reticularis produce
cortisol and androgens. They are regulated by ACTH. (Endocrine pathophysiology, p. 85)

7. CRH decreased, ACTH increased, cortisol increased, adrenal androgen increased by


patient still experiences impotency and decreased libido. Diagnosis?
Cushing’s disease / Pituitary adenoma.
• CRH is decreased because high levels of cortisol feedback on the hypothalamus and
prevent CRH secretion
• ACTH levels remain high because cortisol levels are not high enough to inhibit the
secretion by the tumor
• High ACTH  high cortisol levels
Endocrine Pathophysiology, p. 85-87

8. CRH decreased, ACTH decreased, Cortisol increased, no clinical manifestations of


androgen or mineralocorticoid excess
Adrenal adenoma
• CRH and ACTH are decreased show that the high levels of cortisol are exhibiting
negative feed back on the hypothalamus and pituitary.
• The high level of cortisol implies that there is an inherent problem with the adrenal
glands, such as a tumor that is independently releasing high levels of cortisol.

9. Timmy the turtle moves slowly because of his hypothyroidism, how will his condition
affect his calcitonin levels?
His condition will probably not affect his calcitonin levels. Even though calcitonin is
regulated by the thyroid gland, its release is governed by the level of extracellular calcium
levels.

2
10. E
11. C
12. A
13. D
14. E