Question

Endocrine Case Study

A 54-year old man finally goes to the doctor at the urging of his wife. His face, neck and shoulders have become puffy while his limbs are thinning. He believes he is in good shape because all his friends are gaining weight while he’s just shifting his around. He claims to eat a relatively healthy diet and has no allergies or other health problems. He’s not sure why his arms and legs seem to be getting thinner, even though he still does a lot of yard work around the house, but he hasn’t felt as strong lately (“but hey, I’m 54”). On observation, he has a pulse of 65 bpm and a blood pressure of 150/95. The only other “different” things he’s noticed is that he seems to be bruising more easily than usual.
The patient takes no medications other than an occasional dose of ibuprofen. The patient went to the hospital for a blood draw and test the next morning. The results are:
Plasma ACTH = 120 pg/mL Plasma cortisol = 35 mcg/dL Serum TSH = 3.3 mcU/mL Serum aldosterone = 18 ng/dL Serum insulin = 35 mcU/mL Serum T4 = 1.4 ng/dL Plasma glucose = 185 ng/dL Hemoglobin A1c = 5.5%

Diagnosis:

What is the evidence of Diagnosis:

Answer 1

Diagnosis :

The level of cortisol in the blood is increased

Serum aldosterone levels - increased

Plasma glucose level - decreased due to dec in insulin  

Patient is suffering from Cushing's syndrome :

Signs and symptoms of Cushing's syndrome vary. People who have very high levels of cortisol for a long time are likely to have clear signs of the disorder, including

weight gain

thin arms and legs

a round face

increased fat around the base of the neck

a fatty hump between the shoulders

easy bruising

wide purple stretch marks, mainly on the abdomen, breasts, hips, and under the arms

weak muscles

Children with Cushing’s syndrome tend to have obesity and grow more slowly than other children. Women may have excess hair on their face, neck, chest, abdomen, and thighs. Menstrual periods may become irregular or stop. Men may have decreased fertility with lowered interest in sex and may have erectile dysfunction.

How to diagnose :

Dexamethasone- CRH test

Some people have high cortisol levels off and on but don’t develop the long-term health effects of Cushing's syndrome. These people may have pseudo-Cushing's syndrome, a condition sometimes found in people who have depression or anxiety, drink too much alcohol, have diabetes with blood glucose levels that are often too high, or have obesity

Blood test :

The first step is to measure ACTH levels in the blood. If ACTH levels are low, the cause is probably an adrenal tumor. People with adrenal tumors don’t need further blood tests.

If ACTH levels are normal or high, the cause is probably a pituitary or ectopic tumor.

Other blood tests help tell pituitary tumors from ectopic tumors. Doctors usually do more than one test.

CRH stimulation test. For this test, you’ll get a shot of CRH. If you have a pituitary tumor, CRH will increase the ACTH and cortisol in your blood. This rarely happens in people with ectopic tumors.

High-dose dexamethasone suppression test (HDDST). This test is the same as the LDDST, except it uses higher doses of dexamethasone. If the cortisol levels in your blood drop after taking a high dose of dexamethasone, you probably have a pituitary tumor. If your cortisol levels don’t drop, you may have an ectopic tumor