QUESTION 1

Scenario 1: Syndrome of Antidiuretic Hormone (SIADH)

A 77-year-old female was brought to the clinic by her daughter who stated that her mother had become slightly confused over the past several days. She had been stumbling at home and had fallen twice but was able to walk with some difficulty. She had no other obvious problems and had been eating and drinking. The daughter became concerned when she forgot her daughter’s name, so she thought she better bring her to the clinic.

HPI: Type II diabetes mellitus (DM) with peripheral neuropathy x 30 years. Emphysema. Situational depression after death of spouse 6-months ago

SHFH: – non contributary except for 40 pack/year history tobacco use.

Meds: Metformin 1000 mg po BID, ASA 81 mg po qam, escitalopram (Lexapro) 5 mg po q am started 2 months ago

Labs-CBC WNL; Chem 7- Glucose-102 mg/dl, BUN 16 mg/dl, Creatinine 1.1 mg/dl, Na+116 mmol/L,

K+4.2 mmol/L, CO237 m mol/L, Cl-97 mmol/L.

The APRN refers the patient to the ED and called endocrinology for a consult for diagnosis and management of syndrome of inappropriate antidiuretic hormone (SIADH).

Question:

1. Define SIADH and identify any patient characteristics that may have contributed to the development of SIADH

Scenario 2: Type 1 Diabetes

A 14-year-old girl is brought to the pediatrician’s office by his parents who are concerned about their daughter’s weight loss despite eating more, frequent urination, unquenchable thirst, and fatigue that is interfering with her school activities. She had been seemingly healthy until about 4 months ago when her parents started noticing these symptoms. She admits to sleeping more and gets tired very easily.

PMH: noncontributory.

Allergies-NKDA

FH:- maternal uncle with “some kind of sugar diabetes problem” but parents unclear on the exact disease process

SH: denies alcohol, tobacco or illicit drug use. Not sexually active.

Labs: random glucose 244 mg/dl.

DIAGNOSIS: Diabetes Mellitus type 1 and refers to an endocrinologist for further work up and management plan.

Question

1. Explain the pathophysiology of the three P’s for (polyuria, polydipsia, polyphagia)” with the given diagnosis of Type I DM.

QUESTION 3

Scenario 2: Type 1 Diabetes

A 14-year-old girl is brought to the pediatrician’s office by his parents who are concerned about their daughter’s weight loss despite eating more, frequent urination, unquenchable thirst, and fatigue that is interfering with her school activities. She had been seemingly healthy until about 4 months ago when her parents started noticing these symptoms. She admits to sleeping more and gets tired very easily.

PMH: noncontributory.

Allergies-NKDA

FH:- maternal uncle with “some kind of sugar diabetes problem” but parents unclear on the exact disease process

SH: denies alcohol, tobacco or illicit drug use. Not sexually active.

Labs: random glucose 244 mg/dl.

DIAGNOSIS: Diabetes Mellitus type 1 and refers to an endocrinologist for further work up and management plan.

Question

1. Explain the genetics relationship and how this and the environment can contribute to Type I DM.

QUESTION 4

Scenario 3: Type II DM

A 55-year-old male presents with complaints of polyuria, polydipsia, polyphagia, and weight loss. He also noted that his feet on the bottom are feeling “strange” “like ants crawling on them” and noted his vision is blurry sometimes. He has increased an increased appetite, but still losing weight. He also complains of “swelling” and enlargement of his abdomen.  

PMH: HTN – well controlled with medications. He has mixed hyperlipidemia, and central abdominal obesity. Physical exam unremarkable except for decreased filament test both feet. Random glucose in office 333 mg/dl.

Diagnosis: Type II DM and prescribes oral medication to control the glucose level and also referred the patient to a dietician for dietary teaching. 

Question:

1.     How would you describe the pathophysiology of Type II DM?  

QUESTION 5

Scenario 4: Hypothyroidism

A patient  walked into your  clinic today with the following complaints: Weight gain (15 pounds), however has a decreased appetite with extreme fatigue,  cold intolerance, dry skin, hair loss, and falls asleep watching television. The patient also tearfulness with depression, and with an unknown cause and has noted she is more forgetful.  She does have blurry vision.

PMH: Non-contributory.

Vitals: Temp 96.4˚F, pulse 58 and regular, BP 106/92,  12 respirations. Dull facial expression with coarse facial features. Periorbital puffiness noted.

Diagnosis: hypothyroidism.

Question:

1. What causes hypothyroidism?

RE-Word book answers

1. Define SIADH and identify any patient characteristics that may have contributed to the

development of SIADH

Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) occurs when the pituitary

gland produces too much vasopressin which significantly dilutes sodium in the blood. A normal blood

sodium level is between 135 to 145 mmol/L, and a level much lower than that means SIADH. In this

patient, her sodium levels of 116 mmol/L show that she has hyponatremia, one sign of SIADH. The

patient’s risks include her old age and use of escitalopram, a selective serotonin reuptake inhibitor

(SSRI) which can cause SIADH. COPD (in her case, emphysema) exacerbation can also lead to

SIADH.

3. Explain the genetics relationship and how this and the environment can contribute to

Type I DM.

Some people have genes that get triggered by environmental factors, leading to T1DM. SO these

genes can be carried by certain people and passed on to their children without them having T1DM,

but it is believed that when these genes– the most important of which are located in the HLA class II

locus on the short arm of chromosome 6, come across environmental triggers like dietary gluten, the

seasons (where antibodies develop for some with this genetic characteristic), breastfeeding and cow

milk, gut microbiota, infections, some antibiotics, and even vitamin D absorption. I have to add my

source to give weight to my answer.

4. How would you describe the pathophysiology of Type II DM?

There are two factors that lead to the development of T2DM: the inability of the body tissues to

respond to insulin and an impairment in pancreatic β-cells’ ability to produce insulin. So it’s basically

insulin resistance coupled with impaired insulin secretion that leads to T2DM. When these happen,

muscle cells do not have anywhere to get their energy and the liver cannot build up glycogen stores

that are meant to reserve energy for later use, leading to a rise in blood glucose because it cannot be

used as energy.

5. What causes hypothyroidism?

The most common cause for hypothyroidism I have read is Hashimoto’s thyroiditis (an autoimmune disease) where the immune system attacks the thyroid, leading to impaired hormone release. Stress can also cause it by suppressing the pituitary function. Thyroid surgery, radiation therapy, and some medications like lithium also impairs hormone production. Rarely, it can be caused by iodine

deficiency, pregnancy, or a congenital condition where some individuals are born without a thyroid

gland or one that is impaired already