Which patient assessment finding may indicate adrenal insufficiency after radical nephrectomy? Patient report of back pain Metallic taste in the mouth Bleeding at the surgical site Altered level of consciousness
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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 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.
Josee P.
A 41-year-old African American male complaining of feeling sick over the past 3 months was seen by his physician. His main complaints were feeling very weak and having periodic bouts of dizziness. The patient was 6' 1" and weighed 155 pounds. He reported that he was not always this thin, and said that he lost over 20 pounds during the previous 3 months. His body temperature was 98.6 °F. An examination of his oral cavity showed no redness or swelling, but his gums and oral mucosa were darker in color than normal (hyperpigmentation). His blood pressure when seated was 100 mmHg systolic pressure/70 mmHg diastolic pressure (normal 120/80 mmHg), but when the nurse tried to take a second reading while he was standing systolic pressure fell to 80 mmHg and diastolic pressure fell too low to be accurately determined. Blood was drawn, and the following results came back from the lab: Serum [Na+] = 125 mEq/L (normal 135–148) Serum [K+] = 6.5 mEq/L (normal 3.5–5.3) Serum [Cl-] = 98 mEq/L (normal 96–100) Serum [HCO3-] = 17 mEq/L (normal 20–26) Serum [creatinine] = 1.5 mg/dL (normal 0.7–1.4) Serum pH = 7.31 (normal 7.35–7.45) Serum [glucose] = 76 mg/dL (normal 80–110) Which of the following is the most likely cause of the low serum [glucose] in this patient? Multiple Choice Increased activity of the sympathetic nervous system Increased secretion of cortisol Increased secretion of insulin Increased secretion of growth hormone
Supreeta N.
About a year later, Mr. Smith suddenly began to experience increasing muscle weakness, cramping and tingling, palpitations, generalized fatigue and recurrent headaches. One day he felt very uneasy and asked his coworkers to take him to the emergency room. On physical examination the only significant findings were a documented blood pressure of 210/120 mmHg, a heart rate of 110 bpm and moderate peripheral edema. The rest of his evaluation at the ER revealed the following: Additional routine tests which included a complete blood count (CBC), a chest X-ray and a 12 lead EKG were all unremarkable. An arterial blood gas (ABG) analysis was consistent with a mild metabolic alkalosis with some degree of compensation. An abdominal ultrasound study revealed a suspicious small mass at the level of the right adrenal cortex. Further imaging evaluation with high-resolution CT scan confirmed an adrenal adenoma of the right adrenal cortex. Based on the CT scan results Mr. Smith underwent surgery for removal of the adrenal tumor. Post-operatively, Mr. Smith recovered well without complications and with significant improvement of all his symptoms. His blood pressure began to normalize gradually and after just a few weeks, his doctor was able to completely discontinue all blood pressure medications with no further complaints.
Shaiju T.
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