Living the Sweet life: An Internship in Endocrinology
Part I- Jorge Alvarez
1. What symptoms is Jorge experiencing?
a. Symptoms that Jorge are experiencing include extreme thirst (polydipsia),
tingling in the legs, frequent urination (polyuria), fatigued, and also has a wound
that is healing slowly.
2. Are any of his values on his chart outside normal ranges? If yes, which ones?
a. There are values on Jorge’s chart that are outside normal ranges. BMI is 31.9,
normal is 18.5-24.9; triglycerides at 225 mg/dl, normal is <150 mg/dl; glucose at
178 mg/dl, normal is 75-105 mg/dl; and blood pressure at 155/95, normal is
90-120/60-80 mmHg.
3. What additional information about Jorge’s history would be useful in understanding
his situation? Explain your answer.
a. Additional information about Jorge’s history that would be helping in
understanding his situation is whether or not he has any family history of high
cholesterol or blood pressure. Another thing that would be helpful in
understanding his situation would be if diabetes runs in his family. These are
factors that could lead to Type II Diabetes.
4. What additional tests might assist in your understanding of your patient’s situation?
Explain your rationale for your choice(s)?
a. Additional tests that would be helpful would be a fasting blood sugar test, since
Jorge has had issues with polyuria; a hemoglobin A1c test, due to his terrible
diet; a c-peptide test, because of his unhealthy diet; and a urinary glucose test
would be another test to determine why he may frequently be urinating.
Part I- Janique Johnson
1. What symptoms is Janique experiencing?
a. Symptoms that Janique are experiencing include mood swings/irritable,
headaches, tiredness/fatigue, vomiting, thirst, loss of weight, and an increased
appetite.
2. Are any of her values on her chart outside normal ranges? If yes, which ones?
a. The only value that appeared to be outside the normal range is Janique’s glucose
level which is 130 mg/dl, the normal level is 75-105 mg/dl.
3. What additional information about Janique’s history would be useful in understanding
her situation? Explain your answer.
a. Additional information about Janique’s history that would be helpful in
understanding her situation would be if diabetes runs in the family, as well as if
any family members have suffered from depression or excessive mood swings.
4. What additional tests might assist in your understanding of your patient’s situation?
Explain your rationale for your choice(s)?
a. Additional tests that would be helpful in understanding Janique’s situation would
be a fasting blood sugar test and a urinary glucose test for why she has polyuria;
urinary ketone test, since she has symptoms of losing weight rapidly and eating
non-stop.
Part I- Mary Smith
1. What symptoms is Mary experiencing?
a. Symptoms that Mary are experiencing include tiredness/fatigue, depression,
increased weight, face swelling, increased facial hair, and irregular menstrual
cycles.
2. Are any of her values on her chart outside normal ranges? If yes, which ones?
a. There are values on her chart that are outside the normal range. BMI is 33.7,
normal is 18.5-24.9; triglycerides at 165 mg/dl, normal is <150 mg/dl; blood
pressure is 135/97, normal is 90-120/60-80 mmHg; glucose at 115 mg/dl, normal
is 75-105 mg/dl; sodium at 147 mmol/L, normal is 135-145 mmol/L; potassium at
3.3, normal is 3.5-5.0 mmol/L; and HDL at 41 mg/dl, normal is less than or equal
to 40 mg/dl.
3. What additional information about Mary’s history would be useful in understanding
her situation? Explain your answer.
a. Additional information about Mary’s history that would be helpful in
understanding her situation would be to learn more about how her diet has
been over the past year. Ask Mary if there have been any sudden changes that
may link to why she is gaining so much weight. Another thing to ask Mary would
be if there has been any increased stress in her life over the past few months.
4. What additional tests might assist in your understanding of your patient’s situation?
Explain your rationale for your choice(s)?
a. Additional tests that would be helpful in understanding Mary’s situation would
be a hemoglobin A1c test and a c-peptide test, for her unhealthy diet; morning
cortisol test and DEX challenge test, should be run to see if there is any
correlation to why Mary has increased facial hair growth; and an MRI should be
taken to notice if there is anything wrong in the pituitary gland since she has
increased facial hair growth.
Part II- Jorge Alvarez
5. Based on the data, is Jorge producing adequate insulin? How do you know?
a. Based on the data, Jorge is not producing adequate insulin. His c-peptide levels
were 2.5 ng/ml, which is higher than the normal range of 0.5 to 2 ng/ml. Jorge is
producing insulin, but it is not enough.
6. Based on the data, what is your diagnosis for Jorge? What data support this diagnosis?
a. Based on the data, my diagnosis for Jorge is Type II Diabetes. Jorge has high
levels of c-peptide, blood sugar, glucose, cortisol and A1c in his blood. The cpeptide indicates that the body is not supplying enough insulin. Also, has
detected to have high cholesterol and triglycerides which can increase the
likeliness of developing Type II DM.
7. What treatment would you recommend for this patient?
a. Treatment that I would recommend for Jorge is to change his diet and start
implementing exercise often. Healthy diet changes and exercise can go a long
way, they can also help decrease Jorge’s high cholesterol and triglyceride levels. I
also believe it is important and beneficial that he self-manages his diabetes,
including glucose monitoring and insulin administration.
Part II- Janique Johnson
5. Based on the data, what is your diagnosis for Janique? What data support this
diagnosis?
a. Based on the data, my diagnosis for Janique is Type I Diabetes. Janique has an
elevated urinary ketone test showing 35 mg/dl, normal is very little to none. That
indicated that the body lacked insulin causing her to lose weight. There was a
high level of hemoglobin A1c of 10, normal is <6.5; and a low level of c-peptides
of 0.2, normal is 0.5-2. The low level of c-peptides is another indicator to having
a problem with producing insulin in the body.
6. Dr. Gupta asks you to explain the diagnosis to the patient. Please write out how you
would describe this to Janique.
a. Type I Diabetes is when one’s body does not produce enough insulin. This occurs
when the pancreas stops producing beta cells, which are needed to produce
insulin and help regulate the body’s natural blood sugar levels.
7. What treatment would you recommend for this patient?
a. Treatment that I recommend for Janique is she will be insulin dependent.
Janique needs insulin for her body to function properly, so she shall administer
insulin through a insulin pump or pen. Another treatment on top of that is to
teach and advise Janique to learn how to manage her condition and make sure
she can demonstrate how to do that.
Part II- Mary Smith
5. What would you expect DEX to do to Mary’s ACTH and cortisol levels?
a. I would expect the DEX to suppress the release of Mary’s ACTH and cortisol
levels.
6. Compare the results of Mary’s DEX challenge to her baseline hormone values. What
do Mary’s baseline post-DEX levels tell you about her HPA axis?
a. Mary’s body is going to be producing cortisol which should have been
suppressed through the DEX challenge.
Time
Cortisol Level (ud/dl)
ACTH (pg/ml)
Fasting morning
28
--9-hr post DEX
27
100
7. What diagnosis do the baseline and post-DEX results suggests?
a. The baseline and post-DEX results suggest that there is some form of peritoneal
tumor occurring from the increase in ACTH. It suggests and ACTH secreting
tumor.
8. What are the results of Mary’s MRI scan? What does this tell you about Mary’s HPA
axis?
a. Mary’s brain MRI was clear but the MRI of her body showed lumps in the
peritoneal cavity. HPA axis not working proplery.
9. What is your specific diagnosis for Mary? Which data support this?
a. My specific diagnosis for Mary would be Cushing’s Syndrome. She had new
lumps found and an increase in both ACTH and cortisol levels. More indications
would be face swelling and tiredness/fatigued, her hypertension and
hyperglycemia.
10. What treatment would you recommend for this patient?
a. Mary should have surgery to remove the tumor and then start recovering from
it. She may have to get radiation to help manage the growth of her tumor.
References:
Cushing syndrome. (2019, May 30). Retrieved from https://www.mayoclinic.org/diseasesconditions/cushing-syndrome/symptoms-causes/syc-20351310