A 43yearold female presented with a 15 month history of weig

A 43-year-old female presented with a 15 month history of weight gain, hirsuitism, weakness that had increased over time, and oligomenorrhea. Her blood pressure was 175/105 mm Hg.

Laboratory Data

Sodium                  153 mmol/L

Potassium             2.7 mmol/L

Chloride                 107 mmol/L

Bicarbonate           34 mmol/L

Glucose                 118 mg/dL

The physician ordered an 8:00 a.m. and 4:00 p.m. plasma cortisol. The 8:00 a.m. value was 22 mg/dL and the 4:00 p.m. value was 24 mg/dL.

1.   The laboratory results are most indicative of which of the following disease states? Defend your answer. Also, state why the other disease states CANNOT be the causative agent.

a.    Addison’s disease

b.    Adrenogenital syndrome

c.    Cushing’s syndrome

d.    Conn’s syndrome

2.   What two screening tests are recommended for detecting Cushing’s Syndrome? How are they useful in the diagnosis?

3.   Explain the sodium and potassium levels based on the diagnosis of this patient.

4.   What are the hormones involved, the primary symptoms, and the lab tests used to aid in the diagnosis of the following conditions?

Addison’s disease

Hyperaldosteronism

Adrenogenital syndrome

5.   How are plasma ACTH levels useful in the differential diagnosis of Cushing’s Syndrome?

Solution

1.the patient is likely to suffer from Cushing syndrome due to the symptoms of weight gain., Hirusitim, and high blood pressure and laboratory values too...

In Addisons which is primary mineralocorticoid deficiency there should be less aldosterone and so less sodium reabsorption ..But here sodium values are high above the normal .

adrenogenital syndrome orcongential adrenal hyperplasia can be diagnosed in females at birth by amubigious genitalia and high sex hormones, and deficit of cortisol

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Conn\'s syndrome is primarhyperaldosteronism due to which renin levels become low.. .But due to high ANP sodium excretion occurs in Conn\'s .I.e aldosterone escape mechanism

2 . Dexamethasone suppression test , 24 hr urinary free cortisol , used for screening Cushing syndrome

3. In Cushing\'s there is glucocorticoid and mineralocorticoid hormones excess leading to high aldosterone and thus high sodium retention and lots of potassium excretion

4. Addisons is deficiency of aldosterone , asthenia is the main symptom, ACTH stimulation test/ cosyntrophin test , fasting cortisol levels for diagnosis

Conn\'s is due to hyper aldosterone , poor vision ,weakness are complaints,. Aldosterone renin ratio, saline suppression test are used

.Adrenogenital syndrome -deficiency ofglucocorticoids and / or mineralocorticoid.with excess of sex hormones, ambiguous genitalia at birth , precocious puberty , check for 17 hydroxy progesterone in urine as marker.

5. Cushing\'s syndrome can be ACTH dependant or independent

Dependant - can be pituitary or ectopic sources...If pituitary cause it is Cushing disease . Ectopic include - smallCelL CA.lung, bronchial carcinoids

Independent- adrenal adenoma or carcinoma