Question

Patient's information:

- 40 years old female

- chief complaint: palpitations and chest pains, and tremor for the past few years

- past medical history: hypothyroidism with goiter 7 years ago; still taking medication for it.

- Experiences more anxiousness and depressed, difficulty calming down, increased frequency of heart palpitations, chest pains, and tremors. Notes fluctuations in weight (increasing, losing, increasing, etc) but no changes in diet or exercise.

- Your physical and lab examination reveals:

a) face is slowly becoming more round

b) increased muscle weaknesses and fatigue

c) ELEVATED blood pressure of 160/100 --> blood pressure has been gradually rising for the past 2 years

d) ELEVATED cortisol (11 PM), aldosterone, metanephrine, and normetanephrine

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Questions:

1) What do you think is going on? What tests are you going to order? What other information from her medical history do you need?

2) You send the patient in for a scan. You find out that she has a single bilobular mass in the right adrenal gland. She also has fatty components in the posterior part. Her left adrenal gland is normal though. What's your final diagnosis? Where do you think the adrenal mass has originated from? Lastly, what treatments and lifestyle changes do you prescribe/recommend?

Answer 1

1) the patient condition get worsen when it is going on .And it somay result in exaggerated facial roundness, weight gain around the mid section and upper back , thinning of arms and legs ,easy bruising.So proper treatment should taken for this .

The Patient should do the daignose tests are ,

* ECG

* MRI

* 24 hour urinary cortisol test

* Low- dose dexamethasone suppression test

* Late night salivary cortisol test

Medical history should know about

* If the patient should take any medication,what is the patient detail drug history

* has the Patient gain or lost weight

* Does the patient have muscle weakness and wasting

* Has the Patient developed a change in their menstrual cycle

* Have there is any skin changes :redness ,acne , bruising.

*Has the Patient noticed a change in mood ,for example depression or emotional ability

* Does the Patient have previous history of taking medication for hypertension

* Have the patient developed diabetes or a worsening of their glycemic control

* Are they known or suspected to have osteoporosis.

2) Cushing syndrome. ( Patient having Cushing syndrome which further cause the formation of a small bilobular mass ,it may untreated it become adrenal tumors)

Tumor develop in an organ that normally does not produce ACTH will begin to secrete this hormone in excess , resulting in Cushing syndrome.

# Treatment

* Surgery: primary treatment is to remove the tumor .Type of surgery may be performed,per the surgeon preference,using either a minimally invasive operating microscope or the use of an endoscopy

* Radiation therapy: it may be recommend as additional treatment after surgery to prevent the regrowth of the tumor

* Medications: medications are needed in case where there is persistent or recurrent disease after surgery or in the rare care that surgery is not recommend.

* Supportive service: supporting the Patient as we can - physically, emotionally , spiritually

# Life style changes required

* Watch your diet : avoid fatty foods and eating more high fiber rich food

* Get moving- Exercise gently

* Keep tabs on your mental health :build mental health