A 32 year old male presents to your office for initialevaluation. He is a busy systems analyst for a computermanufacturer who travels a lot, and puts in many hours of work withinadequate rest. He is mildly obese but continues to have a poordiet. He eats fatty foods and does not exercise, aside from when heis running late to an appointment. He snacks often on salty foods.For the past two months, he complains of feeling weak, andoccasionally experiences light-headedness and dizziness that isaccentuated when rising from a supine position. Eventually, hisappetite begins to wane and he starts to losing weight. He ishaving common episodes of diarrhea. His colleagues and friendsnotice that he looks tan, despite spending little time in the sun.He complains about cold weather and tries to avoid cold climatesand temperatures. He is considering relocating to a warmerregion.
When attending a meeting in Denver, he presents to the ERcomplaining of feeling weak; congestion in his head and chest; andsevere abdominal, back, and leg pain. His blood pressure is 70/50mmHG, respiratory rate is 20. Appropriate labs are ordered.
Results:
Sodium= 120 mEq/l
Potassium-6.0 mEq/l
Ratio of serum Na:K= 25:1
Hematocrit= 59
WBC count= 6000
Decreased plasma cortisol and aldosterone
Urine shows increased excretion of Na and decreased excretion ofK
Low levels of hydroxycorticosteroids
What might be causing the pain in the abdomen, back, and legs?Why?
The viral infection poses a kind of stress. Why might thepatient have such a severe reaction?
How do the abnormal Na and K levels relate to adrenalfunction?
Explain the reasons for the elevated hematocrit level.
Why would one see this result in the urine if the adrenal glandis malfunctioning?
What is your diagnosis?
What is ACTH?
Explain why the ACTH level remains elevated.
Why would extra salt intake be appropriate following vomiting ordiarrhea?
A 32 year old male presents to your office for initialevaluation. He is a busy systems analyst for a computermanufacturer who travels a lot, and puts in many hours of work withinadequate rest. He is mildly obese but continues to have a poordiet. He eats fatty foods and does not exercise, aside from when heis running late to an appointment. He snacks often on salty foods.For the past two months, he complains of feeling weak, andoccasionally experiences light-headedness and dizziness that isaccentuated when rising from a supine position. Eventually, hisappetite begins to wane and he starts to losing weight. He ishaving common episodes of diarrhea. His colleagues and friendsnotice that he looks tan, despite spending little time in the sun.He complains about cold weather and tries to avoid cold climatesand temperatures. He is considering relocating to a warmerregion.
When attending a meeting in Denver, he presents to the ERcomplaining of feeling weak; congestion in his head and chest; andsevere abdominal, back, and leg pain. His blood pressure is 70/50mmHG, respiratory rate is 20. Appropriate labs are ordered.
Results:
Sodium= 120 mEq/l
Potassium-6.0 mEq/l
Ratio of serum Na:K= 25:1
Hematocrit= 59
WBC count= 6000
Decreased plasma cortisol and aldosterone
Urine shows increased excretion of Na and decreased excretion ofK
Low levels of hydroxycorticosteroids
What might be causing the pain in the abdomen, back, and legs?Why?
The viral infection poses a kind of stress. Why might thepatient have such a severe reaction?
How do the abnormal Na and K levels relate to adrenalfunction?
Explain the reasons for the elevated hematocrit level.
Why would one see this result in the urine if the adrenal glandis malfunctioning?
What is your diagnosis?
What is ACTH?
Explain why the ACTH level remains elevated.
Why would extra salt intake be appropriate following vomiting ordiarrhea?
