Question

The patient is a 41-year-old Caucasian female who was admitted to the hospital for treatment of an unknown insect bite which caused her left arm to swell considerably. The physician administered dexamethasone to alleviate the swelling. Her physical examination showed dark stiff hair growth on her chest and back, reddening of her palms with a body weight of 211 lbs in addition to the severely swollen arm, so he decided to investigate any other issues the patient may have been having. She complained of general fatigue, weakness, lethargy, mental concentration, and decreased memory over the last 18 months. She also gained 40 lbs over the last two months with central distribution of weight gain and neck obesity. The physician ordered blood to be taken to run a hormone panel. Blood was taken approximately seven hours later. In addition to the following results, the blood report noted elevated glucose, sodium, and WBC count. HORMONE PATIENT STANDARD VALUE Adrenocorticotropin (ACTH) 18.4 1.3 – 16.7 pmol/L Aldosterone (Normal Sodium Diet Adult) 0.99 0.52 – 0.94 nmol/L Cortisol serum 690 am 110 – 607 nmol/L pm 83 - 469 nmol/L Calcitonin 3.2 Female < 6.4 ng/L Male < 13.8 Parathyroid Hormone (PTH) 1.4 1.2 – 5.8 pmol/L Thyroxine (T4 free serum) 9.5 8.5 – 15.2 pmol/L Thyroid-Stimulating Hormone (TSH) 0.4 0.4 – 5.0 μU/mL Vitamin D3 - Cholecalciferol 84 60 – 105 nmol/L Insulin 57 36 – 179 pmol/L Glucagon 142 50 – 200 ng/L As a follow-up, a magnetic resonance imaging (MRI) examination of her brain did not show any abnormal findings. However, a CT scan of the chest with contrast revealed a left upper lobe lung nodule, measuring 1.5x1.5 cm. 3) What glands could be responsible for this dysregulation? Explain. 4) What might you have expected to see on the MRI? Explain. 5) What effect should dexamethasone have on this blood test? Is this similar or different from the result? 6) What does the dexamethasone tell you about the patient's condition? 7) What is your final diagnosis? Explain exactly what you think is happening in this patient.

The patient is a 41-year-old Caucasian female who was admitted to the hospital for treatment of an unknown insect bite which caused her left arm to swell considerably. The physician administered dexamethasone to alleviate the swelling. Her physical examination showed dark stiff hair growth on her chest and back, reddening of her palms with a body weight of 211 lbs in addition to the severely swollen arm, so he decided to investigate any other issues the patient may have been having. She complained of general fatigue, weakness, lethargy, mental concentration, and decreased memory over the last 18 months. She also gained 40 lbs over the last two months with central distribution of weight gain and neck obesity. The physician ordered blood to be taken to run a hormone panel. Blood was taken approximately seven hours later. In addition to the following results, the blood report noted elevated glucose, sodium, and WBC count.

HORMONE
PATIENT
STANDARD VALUE
Adrenocorticotropin (ACTH)
18.4
1.3 – 16.7 pmol/L
Aldosterone (Normal Sodium Diet Adult)
0.99
0.52 – 0.94 nmol/L
Cortisol serum
690
am 110 – 607 nmol/L
pm 83 - 469 nmol/L
Calcitonin
3.2
Female < 6.4 ng/L
Male < 13.8
Parathyroid Hormone (PTH)
1.4
1.2 – 5.8 pmol/L
Thyroxine (T4 free serum)
9.5
8.5 – 15.2 pmol/L
Thyroid-Stimulating Hormone (TSH)
0.4
0.4 – 5.0 μU/mL
Vitamin D3 - Cholecalciferol
84
60 – 105 nmol/L
Insulin
57
36 – 179 pmol/L
Glucagon
142
50 – 200 ng/L

As a follow-up, a magnetic resonance imaging (MRI) examination of her brain did not show any abnormal findings. However, a CT scan of the chest with contrast revealed a left upper lobe lung nodule, measuring 1.5x1.5 cm.

3) What glands could be responsible for this dysregulation? Explain.
4) What might you have expected to see on the MRI? Explain.
5) What effect should dexamethasone have on this blood test? Is this similar or different from the result?
6) What does the dexamethasone tell you about the patient's condition?
7) What is your final diagnosis? Explain exactly what you think is happening in this patient.

case 1 the patient is a 41 year old caucasian female who was admitted to the hospital for treatment of an unknown insect bite which caused her left arm to swell considerably the physician ad 09076

Added by Joshua A.

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