Case Study 013

Please wait while the activity loads.
If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled.

If loading fails, click here to try again

Start

You have completed Case study 013. Your score is %%PERCENTAGE%%. %%RATING%%

Your answers are highlighted below.

Question 1

Andrew is a 13-year-old boy complaining of fatigue, anxiety, irritability, headache, and changes in his face features as well as his body shape. His parents noticed that he gained weight in the last few months, especially on his face and trunk. Andrew has been asthmatic since he was 6-year-old. Last year, his asthma got worse and was only controlled by aggressive therapy.

On examination:

Height: 155 cm, Weight: 56 kg, BMI: 20.8, (91^st percentile)
BP: 155/94 mmHg, Heart rate: 114 /m, Respiratory rate: 24/m, Temperature: 37.1⁰C.
Red round (moon) face, central obesity, purple striae on the abdominal skin.

What asthma medication could be responsible for Andrew’s manifestations?

A	Oral antihistamines
B	Inhaled anticholinergics
C	Oral beta agonists
D	Oral steroids
E	Leukotriene antagonists

Question 1 Explanation:

Based on the clinical symptoms of Andrew, you can suspect that his condition might be caused by one of his medications. In Andrew’s case, the fact that he has been using steroid anti-inflammatory drugs to treat his asthma is particularly important. His condition might be caused by long-term steroid use.

Question 2

On examination:

Height: 155 cm, Weight: 56 kg, BMI: 20.8, (91^st percentile)
BP: 155/94 mmHg, Heart rate: 114 /m, Respiratory rate: 24/m, Temperature: 37.1⁰C.
Red round (moon) face, central obesity, purple striae on the abdominal skin.

What diagnosis do you suspect based on Andrew’s signs and symptoms?

A	Conn's disease
B	Addison's disease
C	Grave's disease
D	Cushing's syndrome
E	Cushing's disease
F	Acromegaly

Question 2 Explanation:

There are some specific symptoms that can lead you to think about Cushing’s syndrome in Andrew’s case: truncal obesity, round face, striae on the abdominal wall, irritability, and anxiety.

Question 3

Here are Andrew's laboratory test results:

Blood analysis:
- CBC:
  - RBCs: 4.8 x 10¹²/ L, Hemoglobin: 140 g/L, Hematocrit: 0.42,
  - MCV: 97 fL, MCH: 34 pg, RDW: 11.8 %, Reticulocytes: 1.3%, ESR: 6 mm/hour,
  - WBC: 6.7 X10⁹/L, (Neutrophils: 2.9 x 10⁹ /L, Lymphocyte: 0.8 x10⁹/L, Basophils: 0.01 x10⁹/L, eosinophils: 0.11x10⁹/L, Monocytes: 0.8 x10⁹/L)
  - Platelet counts: 248 x10⁹/L
- Na: 149 mmol/L, K: 3.1 mmol, Cl: 106 mmol/L, Ca (total): 2.08 mmol/L, Ca (ionized): 1.01 mmol/L,
- Glucose: 9.0 mmol/L, Creatinine: 69.3 u mol/ Uric Acid: 190 mmol/L,
- Triglycerides: 2.0 mmol/L, S. Cholesterol: 4.7 mmol/L, HDL: 1.2mmol/L, LDL: 2.4 mmol/L, Bilirubin: 9 mmol/L, Albumin: 47 g/L
- ACTH (8 am): 0.8 pmol/L, Serum Cortisol (8 am): 996 nmol/L, Aldosterone (recumbent): 1.2 nmol/L,
- Renin activity: 5.6 ug/L/hour
- C- Peptide: 0.94 nmol/L
- TSH: 2.3 uU/mL, Total T₄: 111nmol/L, Free T₄: 11 pmol/L, Total T₃: 2.2 nmol/L, Free T₃: 4.8 pmol/L,
Urinalysis:
- Color: yellow, pH: 7.0, Specific gravity: 1021, Osmolarity: 682 mmol/kg, Glucose: +, Ketones, Albumin, Bilirubin: negative, RBCs and WBCs: 0 and 1-2/HPF, Squamous epithelial cells, Casts, Bacteria: negative, Oxalate crystals: +, Yeast: negative
Urine 24 hours:
- Aldosterone: 65 nmol/24 hours
- Cortisol free: 633 nmol/24 hours
- Catecholamines, total: 326 nmol/m²/24 h

How would you interpret the serum potassium result?

A	Normal
B	Lower than the normal range – caused by the mineralocorticoid effect of cortisol
C	Higher than the normal range – caused by the lack of aldosterone
D	Lower than the normal range – caused by increased aldosterone secretion

Question 3 Explanation:

Glucocorticoids have mineralocorticoid-like action causing sodium and water retention, and potassium excretion. Therefore, patients with Cushing’s syndrome are expected to have hypokalemia.

Question 4

Which of the following hormones is most probably responsible for Andrew’s condition?

A	Thyroxine
B	Cortisol (glucocorticoids)
C	Aldosterone (mineralocorticoids)
D	Glucagon
E	Growth hormone
F	Insulin

Question 5

Which of the followings is/are characteristic/s of glucocorticoids? (select all that apply)

A	Hydrocortisone attains highest levels in the morning.
B	Glucocorticoids can easily cross the cell membrane.
C	The precursor of glucocorticoid synthesis is the arachidonic acid.
D	Glucocorticoids stimulate gluconeogenesis and cause hyperglycemia.
E	Glucocorticoids stimulate bone formation and mineralization.

Question 5 Explanation:

Glucocorticoid secretion follows a circadian rhythm, and the highest level is measured in the morning. Since they are lipid derivatives, glucocorticoids can cross the cell membrane and bind to intracellular receptors. The precursor of glucocorticoid synthesis is cholesterol, not arachidonic acid. Glucocorticoids stimulate gluconeogenesis and increase the blood sugar. They inhibit bone formation and increase bone resorption, so one of the main side effects of long-term steroid use is osteoporosis.

Question 6

Cushing's syndrome refers to a group of clinical signs and symptoms that is caused by the excessive release of glucocorticoid hormones from the adrenal gland. When this condition is caused by pituitary gland tumor and increased secretion of ACTH, the disorder is referred to Cushing's disease.

A	True
B	False

Once you are finished, click the button below. Any items you have not completed will be marked incorrect. Get Results

There are 6 questions to complete.

←

List

→

Return

Shaded items are complete.

1	2	3	4	5
6	End

Return

M	T	W	T	F	S	S
		1	2	3	4	5
6	7	8	9	10	11	12
13	14	15	16	17	18	19
20	21	22	23	24	25	26
27	28	29	30	31