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Based on the data provided, what laboratory tests were performed and what samples were taken from the patient? Select one of the laboratory tests ordered for Mr. Smith and discuss why Mr. Smith’s physician might have ordered the test and the information she might have expected to obtain from that particular test. Select one of the medical terms from the CONCLUSION and DIAGNOSIS section above and define what it means. Also, discuss, in your own words and based on what you can gather about Mr. Smith’s condition, how the laboratory or imaging tests helped with drawing a conclusion or making the diagnosis. In your own words, discuss how medical providers use the scientific method to work through the examination and diagnosis of a patient. Mr. Smith is 60 years old. He was diagnosed with prostate cancer five years ago. Over the past few days, Mr. Smith has been feeling weak and increasingly tired and has also been suffering from a headache that did not respond to over-the-counter medications. He scheduled an appointment with his physician. His physician performed a physical examination and recommended a battery of laboratory tests and imaging procedures. The table below shows Reference values in the right-hand column. These values reflect the normal range of values for patients without disease or illness. The center column reflects the resulting values for medical test results obtained for Mr. Smith. Take note whether Mr. Smith’s values are within normal limits. Mr. Smith Reference Values K+ 2.6 mmol/L 3.8-4.9 mmol/L Hb (Hemoglobin) 7.5 g/dL 13.8 to 18.2 g/dL Hct (Hematocrit) 20.4% 45-52% Platelet Count 49x10^9/L 150-400x10^9/L After receiving Mr. Smith’s test results, his physician admits him to the hospital. Hospital staff treated him and discharged him. The following week, Mr. Smith returns to his physician with the same complaint of weakness and a new complaint of shortness of breath. His blood pressure is 160/100 mmHg. MRI reveals metastasis of prostate cancer to osseous tissue. Abdominal CT shows obstruction of intestine due to nodular enlargement of adrenal glands. Laboratory results from Mr. Smith’s second hospital admission and medical tests show the following findings: Mr. Smith Reference Values K+ 2.6 mmol/L 3.8-4.9 mmol/L Hb 7.3 g/dl 13.8 to 18.2 g/dL Hct 20.4% 45-52% Platelet Count 20x10^9/L 150-400x10^9/L HCO3 38 mmol/l 22-26 mmol/L Urinary K+ 70 mmol/L/24 hr 25-120 mmol/L/24 hr Blood Glucose 460 mg/dl 64.8-104.4 mg/dL Serum Aldosterone 1 ng/dl 24-hour Urinary Aldosterone 8.4 mcg/24 hr 2.3-21.0 mcg/24 hr Renin 2.1 ng/ml/hr 0.65-5.0 ng/ml/hr ACTH (Adrenocorticotropic Hormone) 1082 pg/ml 9-46 pg/ml Cortisol 155.5 microg/dL 0-25 microg/dL CONCLUSION AND DIAGNOSIS Laboratory findings, MRI, and CT confirmed metastatic prostate adenocarcinoma, hypertension, and refractory hypokalemia due to ectopic ACTH production. High levels of circulating cortisol caused continuous activation of mineralocorticoid receptors resulting in hypokalemia, metabolic alkalosis, and hypertension.

Based on the data provided, what laboratory tests were performed and what samples were taken from the patient? Select one of the laboratory tests ordered for Mr. Smith and discuss why Mr. Smith’s physician might have ordered the test and the information she might have expected to obtain from that particular test.

Select one of the medical terms from the CONCLUSION and DIAGNOSIS section above and define what it means. Also, discuss, in your own words and based on what you can gather about Mr. Smith’s condition, how the laboratory or imaging tests helped with drawing a conclusion or making the diagnosis. In your own words, discuss how medical providers use the scientific method to work through the examination and diagnosis of a patient.

Mr. Smith is 60 years old. He was diagnosed with prostate cancer five years ago. Over the past few days, Mr. Smith has been feeling weak and increasingly tired and has also been suffering from a headache that did not respond to over-the-counter medications. He scheduled an appointment with his physician. His physician performed a physical examination and recommended a battery of laboratory tests and imaging procedures.

The table below shows Reference values in the right-hand column. These values reflect the normal range of values for patients without disease or illness. The center column reflects the resulting values for medical test results obtained for Mr. Smith. Take note whether Mr. Smith’s values are within normal limits.

Mr. Smith
Reference Values
K+
2.6 mmol/L
3.8-4.9 mmol/L
Hb (Hemoglobin)
7.5 g/dL
13.8 to 18.2 g/dL
Hct (Hematocrit)
20.4%
45-52%
Platelet Count
49x10^9/L
150-400x10^9/L

After receiving Mr. Smith’s test results, his physician admits him to the hospital. Hospital staff treated him and discharged him.

The following week, Mr. Smith returns to his physician with the same complaint of weakness and a new complaint of shortness of breath. His blood pressure is 160/100 mmHg. MRI reveals metastasis of prostate cancer to osseous tissue. Abdominal CT shows obstruction of intestine due to nodular enlargement of adrenal glands.

Laboratory results from Mr. Smith’s second hospital admission and medical tests show the following findings:

Mr. Smith
Reference Values
K+
2.6 mmol/L
3.8-4.9 mmol/L
Hb
7.3 g/dl
13.8 to 18.2 g/dL
Hct
20.4%
45-52%
Platelet Count
20x10^9/L
150-400x10^9/L
HCO3
38 mmol/l
22-26 mmol/L
Urinary K+
70 mmol/L/24 hr
25-120 mmol/L/24 hr
Blood Glucose
460 mg/dl
64.8-104.4 mg/dL
Serum Aldosterone
1 ng/dl
24-hour Urinary Aldosterone
8.4 mcg/24 hr
2.3-21.0 mcg/24 hr
Renin
2.1 ng/ml/hr
0.65-5.0 ng/ml/hr
ACTH (Adrenocorticotropic Hormone)
1082 pg/ml
9-46 pg/ml
Cortisol
155.5 microg/dL
0-25 microg/dL

CONCLUSION AND DIAGNOSIS

Laboratory findings, MRI, and CT confirmed metastatic prostate adenocarcinoma, hypertension, and refractory hypokalemia due to ectopic ACTH production. High levels of circulating cortisol caused continuous activation of mineralocorticoid receptors resulting in hypokalemia, metabolic alkalosis, and hypertension.

Added by Anna W.

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