Case #17: 32-year-old Male This patient was referred to the outpatient endocrino

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Case #17: 32-year-old Male This patient was referred to the outpatient endocrinology clinic with complaints of excessive weight gain and muscle weakness. He reported to have gained 8 kgs in 12 months. Physical examination revealed a moon face appearance, truncal obesity, a buffalo hump, hirsutism, and purple striae in the axilla, periumbilical, and inguinal regions. Numerous erythematous, scaly psoriatic plaques were located on the shoulders, extremities, hands, and feet. Vital signs revealed an arterial blood pressure of 130/80 mmHg, pulse rate 75/min, height 172 cm, weight 85 kg, and body mass index 28.7 kg/cm2. On laboratory studies, liver and kidney function tests and fasting blood glucose were within normal limits. The following were found: morning adrenocorticotropic hormone (ACTH): 17 : 53 pg/ml (N: 7.2–63.3); morning basal cortisol: 3.83 mg/dL (–18.0). Other anterior hypophyseal hormones were as follows: thyroid stimulating hormone (TSH): 2.77 /ml (N: 0.27–4.2); fT4: 17.6 pmol/L (N: 12–22); fT3: 7.26 pmol/L (N: 3.1–6.8); prolactin: 7.34 ng/ml (N: 4.04–15.2); follicle stimulated hormone (FSH): 3.81 mIU/mL; luteinizing hormone (LH): 2.7 mIU/mL; total testosterone: 2.77 ng/mL (N: 2.9–8.36). 1 g ACTH stimulation test was performed to evaluate hypophyseal-adrenal axis and there was insufficient response to the test (peak cortisol level 7.7 mg/dL). Patient History: 12 years ago, he was diagnosed with psoriasis vulgaris. To treat this condition, he used clobetasol propionate 00.5% ointment continuously at 150 mg/week for the past 12 years, but stopped treatment independently one month prior to referral. Family History: No history of any chronic or acute conditions, very healthy parents. 1.) What is the most likely candidate hormone at the root of the homeostatic imbalance? 2.) What hormone feedback loop disrupted in the patient? 3.) What is some further information based on what was stated that you would like to know before the final diagnosis? Case #17: 32-year-old Male This patient was referred to the outpatient endocrinology clinic with complaints of excessive weight gain and muscle weakness. He reported to have gained 8 kgs in 12 months. Physical examination revealed a moon face appearance, truncal obesity, a buffalo hump, hirsutism, and purple striae in the axilla, periumbilical, and inguinal regions. Numerous erythematous, scaly psoriatic plaques were located on the shoulders, extremities, hands, and feet. Vital signs revealed an arterial blood pressure of 130/80 mmHg, pulse rate 75/min, height 172 cm, weight 85 kg, and body mass index 28.7 kg/cm2. On laboratory studies, liver and kidney function tests and fasting blood glucose were within normal limits. The following were found: morning adrenocorticotropic hormone (ACTH): 17 : 53 pg/ml (N: 7.2–63.3); morning basal cortisol: 3.83 mg/dL (–18.0). Other anterior hypophyseal hormones were as follows: thyroid stimulating hormone (TSH): 2.77 /ml (N: 0.27–4.2); fT4: 17.6 pmol/L (N: 12–22); fT3: 7.26 pmol/L (N: 3.1–6.8); prolactin: 7.34 ng/ml (N: 4.04–15.2); follicle stimulated hormone (FSH): 3.81 mIU/mL; luteinizing hormone (LH): 2.7 mIU/mL; total testosterone: 2.77 ng/mL (N: 2.9–8.36). 1 g ACTH stimulation test was performed to evaluate hypophyseal-adrenal axis and there was insufficient response to the test (peak cortisol level 7.7 mg/dL). Patient History: 12 years ago, he was diagnosed with psoriasis vulgaris. To treat this condition, he used clobetasol propionate 00.5% ointment continuously at 150 mg/week for the past 12 years, but stopped treatment independently one month prior to referral. Family History: No history of any chronic or acute conditions, very healthy parents. 1.) What is the most likely candidate hormone at the root of the homeostatic imbalance? 2.) What hormone feedback loop disrupted in the patient? 3.) What is some further information based on what was stated that you would like to know before the final diagnosis? Case #17: 32-year-old Male This patient was referred to the outpatient endocrinology clinic with complaints of excessive weight gain and muscle weakness. He reported to have gained 8 kgs in 12 months. Physical examination revealed a moon face appearance, truncal obesity, a buffalo hump, hirsutism, and purple striae in the axilla, periumbilical, and inguinal regions. Numerous erythematous, scaly psoriatic plaques were located on the shoulders, extremities, hands, and feet. Vital signs revealed an arterial blood pressure of 130/80 mmHg, pulse rate 75/min, height 172 cm, weight 85 kg, and body mass index 28.7 kg/cm2. On laboratory studies, liver and kidney function tests and fasting blood glucose were within normal limits. The following were found: morning adrenocorticotropic hormone (ACTH): 17 : 53 pg/ml (N: 7.2–63.3); morning basal cortisol: 3.83 mg/dL (–18.0). Other anterior hypophyseal hormones were as follows: thyroid stimulating hormone (TSH): 2.77 /ml (N: 0.27–4.2); fT4: 17.6 pmol/L (N: 12–22); fT3: 7.26 pmol/L (N: 3.1–6.8); prolactin: 7.34 ng/ml (N: 4.04–15.2); follicle stimulated hormone (FSH): 3.81 mIU/mL; luteinizing hormone (LH): 2.7 mIU/mL; total testosterone: 2.77 ng/mL (N: 2.9–8.36). 1 g ACTH stimulation test was performed to evaluate hypophyseal-adrenal axis and there was insufficient response to the test (peak cortisol level 7.7 mg/dL). Patient History: 12 years ago, he was diagnosed with psoriasis vulgaris. To treat this condition, he used clobetasol propionate 00.5% ointment continuously at 150 mg/week for the past 12 years, but stopped treatment independently one month prior to referral. Family History: No history of any chronic or acute conditions, very healthy parents. 1.) What is the most likely candidate hormone at the root of the homeostatic imbalance? 2.) What hormone feedback loop disrupted in the patient? 3.) What is some further information based on what was stated that you would like to know before the final diagnosis? Case #17: 32-year-old Male This patient was referred to the outpatient endocrinology clinic with complaints of excessive weight gain and muscle weakness. He reported to have gained 8 kgs in 12 months. Physical examination revealed a moon face appearance, truncal obesity, a buffalo hump, hirsutism, and purple striae in the axilla, periumbilical, and inguinal regions. Numerous erythematous, scaly psoriatic plaques were located on the shoulders, extremities, hands, and feet. Vital signs revealed an arterial blood pressure of 130/80 mmHg, pulse rate 75/min, height 172 cm, weight 85 kg, and body mass index 28.7 kg/cm2. On laboratory studies, liver and kidney function tests and fasting blood glucose were within normal limits. The following were found: morning adrenocorticotropic hormone (ACTH): 17 : 53 pg/ml (N: 7.2–63.3); morning basal cortisol: 3.83 mg/dL (–18.0). Other anterior hypophyseal hormones were as follows: thyroid stimulating hormone (TSH): 2.77 /ml (N: 0.27–4.2); fT4: 17.6 pmol/L (N: 12–22); fT3: 7.26 pmol/L (N: 3.1–6.8); prolactin: 7.34 ng/ml (N: 4.04–15.2); follicle stimulated hormone (FSH): 3.81 mIU/mL; luteinizing hormone (LH): 2.7 mIU/mL; total testosterone: 2.77 ng/mL (N: 2.9–8.36). 1 g ACTH stimulation test was performed to evaluate hypophyseal-adrenal axis and there was insufficient response to the test (peak cortisol level 7.7 mg/dL). Patient History: 12 years ago, he was diagnosed with psoriasis vulgaris. To treat this condition, he used clobetasol propionate 00.5% ointment continuously at 150 mg/week for the past 12 years, but stopped treatment independently one month prior to referral. Family History: No history of any chronic or acute conditions, very healthy parents. 1.) What is the most likely candidate hormone at the root of the homeostatic imbalance? 2.) What hormone feedback loop disrupted in the patient? 3.) What is some further information based on what was stated that you would like to know before the final diagnosis?

Explanation / Answer

The patient is suffering with cushings disease

the root cause of homeostatic imbalance is due to cortisol.i t plays a role in salt and water homeostasis

The physiological control of cortisol synthesis in adrenal cortex involves stimulation of ACTH by the hypothalamic corticotropin releasing hormone.a nd then the stimulation of adrenal by ACTH.This is a negative feedback of cortisol on hypothalamus and pituitary.this nenegative feedback loop is disrupted in cushings disese.

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