Question

Give 1 case study for Growth hormone and 1 case study for ACTH hormone, and explain each diagnosis as well as how it should be manage.

Answer 1

Answer :

Case study for Growth hormone:

A 19 year old woman comes to Endocrinology clinic complaining of Short stature compare with her siblings. She had medical history of Precocious puberty and she started to have irregular menses at age of 5 years and become regular only when she was 10 years. she reported that breasts starts to develop since early childhood but no Galactorrhoea observed. and no history of bone fractures.

Physical examination of young woman with short stature: Height : 1.37m , Weight: 39kg , temperature: 37.2c , Pulse rate 85 beats per minute, Blood pressure : 112/69mm Hg., Breasts are well developed and with adequate pubic hair distribution , Normal external female genitalia and normal clitoris.

Diagnosis of this case:

The patient serum insuline growth factor 1 (IGF-1) level is low and growth hormone defeciency is seen in serum by clonidine test . if growth hormone is less than 5 ng/mL noted it means growth hormone deficiency.

Short stature is related to both growth hormone deficiency and Precocious puberty which means child body begin to change into adult's body in early age.  Premature fusion of Epiphysial secondary growth plates to defect in Osteoblastic differentiation and maturation which results in short stature.

- Growth hormone deficiency is due to her phenotype. if patient had Precocious puberty Oestrogen excess production happens which accelerated to bone maturation and short stautre.

Management:

the patient should lose body fat and excercise with high intesity which helps body , fasing once a week , reduce sugar intake everyday and not to eat more food before bed time , take GABA supplements to improve in growth naturally.

- The coomon treatment is growth hormone therapy and injecting the patient with somatotropin injections help in the growth hormone changes.

Case study for ACTH hormone:

A 55 years aged man presented with 3 months of Fatigue and Hypertension. He said he has easy bruising and thigh weakness and had history of Hyperlipidaemia, recent weight gain and vertebral compression fractures. his family members had history of non functional benign adrenal adenomas. his medications were Ramipril, Carvedilol, Spironolactone , Potassium chloride and aspirin.

Physical examination: classic Cushingoid features of facial plethora, round face, central obesity, dorsal ceervical fat pad and lower extremity edima. Blood pressure is like 180/120 mm Hg.

Diagnosis:

Adrenal Cushing syndrome is diagnoised in this patient.The patient shows Hypercortisolaemia with AM Cortisol with 31.2 mcg/ dL because normal levle of cortisol is less than 22 mcg/dL. and also diagnoised with non suppressed Adrenocorticotropic hormone is 18 pg/mL.

Normally ACTH levels are increased when cortisol level is low and ACTH level decreases when cortisol level is high. Corticotropin releasing hormone stimulation test is failed to stimulate the cortisol and Adrenocorticotropic hormone. A brain MRI and CT of chest , abdomen and pelvis shows no amount ACTH production.

Management:

The patient is treated with medications like Alpha blockade with Phenoxybenzamine and Nifedipine and gives oral fliuds. This patient has hypertension so blood pressure should be reduced by Orthostatic hypotension means low BP happens due to stand up from sitting or lying down.

After patient shows no fluctuations in blood pressure then perform surgery of left Laproscopic Adrenalectomy in which the adrenal gland is removed surgically. Blood pressure is maintained with the use Nifedipine and Enalpril and cortisol level is normal after surgery.