Endocrinology Case Study 1

Case 1

• A 33-year-old woman presents with nausea, vomiting, fatigue, lack of energy, and weight loss for 6 months
• She has previously been diagnosed with hypothyroidism a year ago and is currently on levothyroxine medication.
• Upon examination, the patient appears pale, listless, dehydrated, and has low blood pressure and a high pulse rate.

Case 1 Blood Results

• Sodium levels are low at 128 umol/L (normal range: 133 - 146 umol/L)
• Potassium levels are high at 5.7 mmol/L (normal range: 3.5 - 5.3 mmol/L)
• Urea levels are high at 16.7 mmol/L (normal range: 2.5 – 7.8 mmol/L)
• Creatinine levels are high at 82 umol/L (normal range: 45 - 84 umol/L)
• Plasma glucose levels are very low at 2.2 mmol/l (normal range: 4 - 11 mmol/l)
• Amylase levels are within the normal range at 42 IU/L (normal range: 30 - 118 IU/L)

Case 1 Investigations & Diagnosis

• Investigations to confirm diagnosis: Measure cortisol levels and ACTH levels.
• Other relevant investigations: Thyroid function tests, full blood count, liver function tests, CT scan of the abdomen.
• Suggested diagnosis: Addisonian crisis due to inadequate cortisol production.

Case 1 Management

• Immediate Treatment: Administer intravenous hydrocortisone (100mg) to replace cortisol immediately.
• Long-term treatment: Lifetime replacement therapy with oral corticosteroids such as hydrocortisone to replace the missing cortisol.
• Patient discharge advice: Educate the patient on how to self-administer steroids, and ensure they have a medical alert bracelet outlining their condition.

Case 2

• A 45-year-old woman presents with high fever, agitation, confusion, and weight loss.
• She has a history of type 2 diabetes mellitus, is on metformin and has had two previous C-sections.
• The patient also reports palpitations, somnolence, and restlessness for a few days.
• Clinical examination reveals agitation, sweaty palms, and abnormally elevated temperature, blood pressure, pulse, and respiration rates.

Case 2 Blood Results

• Sodium levels are within the normal range at 135 umol/L (normal range: 133 - 146 umol/L)
• Potassium levels are within the normal range at 3.8 mmol/L (normal range: 3.5 - 5.3 mmol/L)
• Urea levels are within the normal range at 9.2 mmol/L (normal range: 2.5 – 7.8 mmol/L)
• Creatinine levels are high at 110 umol/L (normal range: 45 - 84 umol/L)
• Protein levels are within the normal range at 65 g/L (normal range: 60 - 80 g/L)
• Albumin levels are low at 42 g/L (normal range: 35 - 50 g/L)
• Bilirubin levels are high at 10 umol/L (normal range unreported but elevated)