Question

Mr. Smith is 60 years old. He was diagnosed with a prostate cancer five years ago. Over the past few days, Mr. Smith has been feeling weak and increasingly tired and has also been suffering from a headache that did not respond to over-the-counter medications. He scheduled an appointment with his physician.

His physician performed a physical examination and recommended a battery of laboratory tests and imaging procedures.

The table below shows Reference values in the right-hand column. These values reflect the normal range of values for patients without disease or illness. The center column reflects the resulting values for medical test results obtained for Mr. Smith.

Take note whether Mr. Smith’s values are within normal limits.

	Mr. Smith	Reference Values
K+	2.6 mmol/L	3.8-4.9mmol/L
Hb (Hemoglobin)	7.5 g/dL	13.8 to 18.2 g/dL
Hct (Hematocrit)	20.4%	45-52%
Platelet Count	49x109/L	150-400x109/L

After receiving Mr. Smith’s test results, his physician admits him to the hospital. Hospital staff treated him and discharged him.

The following week, Mr. Smith returns to his physician with the same complaint of weakness and a new complaint of shortness of breath. His blood pressure is 160/100 mmHg. MRI reveals metastasis of prostate cancer to osseous tissue. Abdominal CT shows obstruction of intestine due to nodular enlargement of adrenal glands.

Laboratory results from Mr. Smith’s second hospital admission and medical tests show following findings:

Mr. Smith	Reference Values
K+	2.6 mmol/L	3.8-4.9mmol/L
Hb	7.3 g/dl	13.8 to 18.2 g/dL
Hct	20.4%	45-52%
Platelet Count	20x109/L	150-400x109/L
HCO3	38 mmol/l	22-26 mmol/L
Urinary K+	70 mmol/L/24 hr	25-120 mmol/L/24 hr
Blood Glucose	460 mg/dl	64.8-104.4 mg/dL
Serum Aldosterone	1 ng/dl
24 hour Urinary Aldosterone	8.4 mcg/24 hr	2.3-21.0 mcg/24 hr
Renin	2.1 ng/ml/hr	0.65-5.0 ng/ml/hr
ACTH (Adrenocorticotropic Hormone)	1082 pg/ml	9-46 pg/ml
Cortisol	155.5 microg/dL	0-25 microg/dL

CONCLUSION AND DIAGNOSIS

Laboratory findings, MRI and CT confirmed metastatic prostate adenocarcinoma, hypertension and refractory hypokalemia due to ectopic ACTH production. High levels of circulating cortisol caused continuous activation of mineralocorticoid receptors resulting in hypokalemia, metabolic alkalosis and hypertension.

QUESTION:

Compare Mr. Smith’s values with reference values and indicate whether MR. Smith’s values are below, above, or within normal range (compare Mr. Smith’s values with the Reference values) for each laboratory tests in the table above from the second set of tests.

Answer 1

K+ test

Low potassium (hypokalemia) refers to a lower than normal potassium level in the bloodstream. Potassium is a chemical (electrolyte) that is critical to the proper functioning of nerve and muscles cells, particularly heart muscle cells.

Normally, the blood potassium level is 3.6 to 5.2 millimoles per liter (mmol/L). Mr.Smith is having 2.6 mmol/L which is low. A very low potassium level (less than 2.5 mmol/L) can be life-threatening and requires urgent medical attention.

Hb test

Hb is the heamoglobin normal range is 13.6 to 17.0 g/dL. Mr.Smith is having 7.3 g/dl which is low. this results in aneamia.

Hct test

The hematocrit(hct) is the proportion, by volume, of the blood that consists of red blood cells.The normal range is 38.8 to 50%. Mr. Smith is having 20.4% which is very low.

Platelet count

A normal platelet count ranges from 150,000 to 450,000 platelets per microliter of blood. Mr.Smith is having very low count

HCO3 test

The normal range is 22-28 mmol/L. Mr.Smith is having 38 mmol/L which is high.

Urinary K+

The normal range is 25-125 mmol/L/24 hr. Mr.Smith is having 70mmol/L/24 hr which is within the normal range.

Blood glucose test

The normal range is 100-125 mg/dL. Mr.Smith is having 460 mg/dl which is very high.

Serum Aldosterone test

The normal range is while standing or sitting 7-30 ng/dL or 0.19-0.83 nmol/L and it is 3-16 ng/dL or 0.08-0.44 nmol/L while lying down. Mr.Smith is having1 ng/dL which is low.

24 hour Urinary Aldosterone test

The normal range is 0-30 days: 0.7-11.0 mcg/24 hours

31 days-11 months: 0.7-22.0 mcg/24 hours

> or =1 year: 2.0-20.0 mcg/24 hours

Mr.Smith is having 8.4 mcg/24 hr which is within the normal range

Renin test

Normal values range from 0.2 to 3.3 ng/mL/hour.Mr.Smith is having 2.1 ng/ml/hr which is within the normal range.

ACTH (Adrenocorticotropic Hormone) test

Normal values for a blood sample taken early in the morning are 9 to 52 picograms per milliliter (pg/mL).Mr.Smith is having 1082 pg/ml which is abnormally high.

Cortisol test

The normal range is 5-23 micrograms per deciliter (mcg/dL) in the morning and 3-16 mcg/dL in the afternoon . Mr.Smith is having 155.5 microg/dL which is very high