CASE STUDY # 3 History A 27-year-old woman presents with depression, insomnia. increased facial fullness and...

  

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CASE STUDY # 3 History A 27-year-old woman presents with depression, insomnia. increased facial fullness and recent inorease in facial hair (hirsutism). She had also had an episode of depression and acute psychosis following uncomplicated delivery of normal baby boy 0 months previously. Her menses have been irregular since their resumption after the birth (she is not breastfeeding). Physical Exam • Heart rate was 00 beats per minute • Blood pressure was 148/110. • Her face was puffy with an increase in facial hair and ruddy complexion. • There was no truncal obesity, peripheral wasting, or striae Laboratory Studies • Because the symptoms in this case are fairly nonspecific, tests were carried out to evaluate her endoorine gland funations. Lab Test Patient Reference 3.2 uU/ml 0.7-7.OUU/ml TSH (Serum/blood) T3. Total (Serum/blood) T4, Total (Serum/blood) Prolactin (Serum/blood) LH. mid-follicular (Serum/blood) FSH. mid-follicular (Serum/blood) Cortisol 24:00 (night. Serum/blood) Cortsol 06 00 (morning Serum/blood) ACTH 08 00 (morning Plasma) Cortisol (24 hr unine) 100 ng/di 62 vg/di 14 ng/m O mU/ml 75-200 ng/di 4.0- 12 vg/di Nonpreg <20 ng/ml 5-20 mU/ml 10 mU/ml 37 ugid 40 ug/d 135 poim 180 ug 2.6- 16 mU/ml <5 ugidl 5-25 ugid < 100 pg/mi 20 - 00 ug 4 Questions 1. What is notable or abnormal in this patient? List evidence for each of the following: a. Patient history b. Physical exam o. Laboratory tests 2. What hormone is usually responsible for hirsutism? 3. What hormone(s) that we discussed in this unit could be responsible for her hypertension? 4. Which organ can make hormones that can cause hirsutism and hypertension? 5. What hommone normally stimulates this organ/gland? When this hormone stimulates the organ/gland, what hormone will be produced and elevated? 6. Based on all the evidence, what is the final diagnosis (name of the disease)? Describe or draw the pathway explaining where the problem originated and how it resulted in the physical and laborafory resulte, CASE STUDY # 3 History A 27-year-old woman presents with depression, insomnia. increased facial fullness and recent inorease in facial hair (hirsutism). She had also had an episode of depression and acute psychosis following uncomplicated delivery of normal baby boy 0 months previously. Her menses have been irregular since their resumption after the birth (she is not breastfeeding). Physical Exam • Heart rate was 00 beats per minute • Blood pressure was 148/110. • Her face was puffy with an increase in facial hair and ruddy complexion. • There was no truncal obesity, peripheral wasting, or striae Laboratory Studies • Because the symptoms in this case are fairly nonspecific, tests were carried out to evaluate her endoorine gland funations. Lab Test Patient Reference 3.2 uU/ml 0.7-7.OUU/ml TSH (Serum/blood) T3. Total (Serum/blood) T4, Total (Serum/blood) Prolactin (Serum/blood) LH. mid-follicular (Serum/blood) FSH. mid-follicular (Serum/blood) Cortisol 24:00 (night. Serum/blood) Cortsol 06 00 (morning Serum/blood) ACTH 08 00 (morning Plasma) Cortisol (24 hr unine) 100 ng/di 62 vg/di 14 ng/m O mU/ml 75-200 ng/di 4.0- 12 vg/di Nonpreg <20 ng/ml 5-20 mU/ml 10 mU/ml 37 ugid 40 ug/d 135 poim 180 ug 2.6- 16 mU/ml <5 ugidl 5-25 ugid < 100 pg/mi 20 - 00 ug 4 Questions 1. What is notable or abnormal in this patient? List evidence for each of the following: a. Patient history b. Physical exam o. Laboratory tests 2. What hormone is usually responsible for hirsutism? 3. What hormone(s) that we discussed in this unit could be responsible for her hypertension? 4. Which organ can make hormones that can cause hirsutism and hypertension? 5. What hommone normally stimulates this organ/gland? When this hormone stimulates the organ/gland, what hormone will be produced and elevated? 6. Based on all the evidence, what is the final diagnosis (name of the disease)? Describe or draw the pathway explaining where the problem originated and how it resulted in the physical and laborafory resulte,