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Oct 30, 2023

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Test Result Rovick, AA, Michael JA. Problem Solving in Physiology;1999 Problem 3 You must show all your work and if I cannot read it, it will be counted wrong. PROBLEM INTRODUCTION A patient often exhibits signs and symptoms that could have resulted from any of a number of causes. To determine the specific cause that is operating in a particular case requires that the student know the possible causes and know what to measure that will allow these causes to be differentiated. The subject in this problem exhibits an assemblage of symptoms that could arise from a variety of causes. Ms. Organa is a 44-year old lawyer who was referred to a physician by her dentist, who noted; hyperpigmentation of her gums. In any case, she had been meaning to see a doctor because of weakness, fatigue, and lightheadedness. She also stated that she had read an article in a magazine that convinced her that she was suffering from hypoglycemia: she develops a rapid heartbeat, shakiness, sweating, and faintness if she does not eat promptly on arising in the morning or if she misses a meal. These symptoms are relieved 15 to 20 minutes after eating. It is January in Chicago, yet the patient, who has not traveled, looks as though she just returned from a vacation in the Caribbean. 1. What are the possible causes of "lightheadedness" or "faintness"? Possible causes of lightheadedness are fear, emotional trauma, severe pain, sudden drop in blood pressure, low blood sugar due to diabetes, hyperventilation, standing in one position for too long, standing up too quickly, physical exertion in hot temperatures, coughing too hard, straining during bowl movement, consumption of drugs or alcohol, seizures, and medications that drop blood pressure. Diseases such as diabetes, heart disease, atherosclerosis, anirregular heartbeat or arrhythmia, and anxiety or panic attacks can also cause lightheadedness or faintness. 2. What are the possible hormonal and metabolic causes of hypoglycemia?

Possible causes for hypoglycemia include insulin excess due to accidental intake or beta cell tumor of pancreas. Counter regulatory hormone deficiencies such as growth hormone, thyroxine, glucagon and epinephrine. These hormones increase the blood glucose levels. When these hormones are deficient, hypoglycemia may occur. Fatty acid oxidation disorders may be long chain and medium chain fatty acids oxidation disorders resulting in fats not being able to convert to glucose during fasting state leading to hypoglycemia. Gluconeogenic disorders such as a deficiency in fructose 1,6 biphosphate causes hypoglycemia. Glycogen storage disorders also cause hypoglycemia. 3. What could be the cause of Ms. Organa's symptoms upon missing a meal? The acute symptoms of Ms. Organa is due to Addisonian crisis precipitated by hypoglycemia. She may be suffering from Addison’s disease (chronic adrenal insufficiency) which resulted in the crisis. The patient has symptoms of weakness, fatiguability, dizziness, hyperpigmentation of gums, and hypoglycemia (evident by tachycardia, tremors, sweating and syncope on missing a meal, immediately reverts back to normal on taking food. These symptoms suggest a diagnosis of adrenocortical insufficiency. 4. What pathophysiological mechanism(s) might be responsible for the signs and symptoms exhibited by Ms. Organa? What data in the patient's description lead you to this hypothesis (these hypotheses)? Brain dysfunction due to decrease in uptake of glucose by the brain cells and Hypoglycemia will activate the sympathetic nervous system, which is responsible for the rapid heartbeat, shakiness, sweating, faintness. As mentioned in question the symptoms of light headiness, shakiness, rapid heartbeats, sweating, faintness, These are observed in patient with extremely low blood glucose level usually seen among patient undergoing diabetes treatment. 5. What would you do to test your hypothesis (hypotheses)? To test the hypothesis, ask the patient to undergo diabetes test and modify the medications causing the low blood glucose levels. Increase the blood the glucose level with food and by using proper external supplements. Dextrose is best treatment in severe cases. Plan meals no skipping meals. 6. Do these data support or refute your hypothesis (hypotheses) about what is wrong with Ms. Organa? What leads you to that conclusion? From the blood reports and the symptoms of the patient, we can infer that this is a case of Addison’s disease. 7. What would you do to test your hypothesis (hypotheses)? Synacthen test is used to measure of adrenal insufficiency which is used as a confirmatory test for adrenal gland. This test is based on the measurement of serum cortisol before and after injection of synthetic ACTH (tetracosactrin). 8. Why were the hormone measurements made in the morning?

The main function of this hormone is it helps the body respond to stress, regulate blood sugar and fight infection. So the hormone levels are highest in the morning when the person is awake and lowest around midnight. 9. What’s wrong with Ms. Organa? Ms. Organa is suffering from Addison's disease in which the adrenal gland cannot produce enough hormones. Primary adrenal insufficiency is the damage of the adrenal gland cortex because of autoimmune disease. In autoimmune disease for some unknown reason the body immune system views the adrenal cortex as foreign and attacks and destroys it. Another is secondary adrenal insufficiency in which the pituitary gland fails to produce ACTH which stimulates the adrenal cortex. This can be due to benign pituitary tumors, inflammation or pituitary surgery is some of the leading cause of not producing enough pituitary hormones 10. Draw a concept map that shows the causal relationships between Ms. Organa's disorder and her signs, symptoms, and laboratory values.

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