Question

1. A 45-year-old male from the Midwest presented with the following symptoms during February: weakness, fatigue, orthostatic hypotension, weight loss, dehydration, and decreased cold tolerance. His blood chemistry values follow:

Serum sodium	128 mEq/L
Serum potassium	6.3 mEq/L
Fasting blood glucose	65 mg/dL
BUN	4.5 mg/dL
Serum creatinine	0.5 mg/dL

Hematology tests resulted in the following values:

Hematocrit	50%
Leukocytes	5000/cu mm

3). He also noticed increased pigmentation (tanning) of both exposed and nonexposed portions of the body and back. A plasma cortisol determination indicated a low cortisol level. Following administration of ACTH, plasma cortisol did not rise significantly after sixty and ninety minutes. Endogenous circulating levels of ACTH were later determined to be significantly elevated.

Top of Form

1. What endocrine organ is the site of the malfunction?

2. Is this a primary or secondary disturbance?

3. What is the name of this disorder?

4. Discuss the electrolyte disturbances resulting from this disorder.

5. Discuss the metabolic disturbances resulting from this disorder

6. What is the cause of the tanning?

6. What type of replacement therapy would be required for this individual?

7. Describe the feedback loop for this endocrine disorder.

Answer 1

1. Adrenal glands

2. Primary disturbance

3. Addison's disease/Addison's crises due to end organ damage by tumor.

4. Hyponatremia and Hyperkalemia - due to decreased aldosterol

5. Hypoglycemia - due to decresed cortisole

6. Increased ACTH is responsible for tabning, as ACTH acts similar to MSH.

7. injection of glucocorticoid, salt water (saline), and sugar (dextrose)

8. Hypoglycemia due decresed cortisol --> Stimulation of Hypothalamus and pitutary --> Increased CRH & ACTH --> adrenal dyfuntion. Lead to tanning of skin and othet features.