W12 Worksheet: Endocrine Case
Study
Follow the instructions below very carefully. Many of the items in this assignment require
reading, or videos, or something else to do. Each question has either a text box that can be
filled out or a box that can be checked to show completion. Be sure to type out your answers
completely and expand the text boxes if you need the additional space.
Question 1 --- 3 points
Endocrine Case Study
The endocrine system secretes different types of hormones directly into the bloodstream.
Some of these hormones are transported on carrier proteins and some are dissolved directly in
the plasma. Our hormones regulate a large range of physiological functions. If a person
experiences hormonal dysfunction, physiological homeostasis is lost, and symptoms arise.
Medical professionals trying to track down a cause for a patient’s symptoms and complaints
must know the endocrine system well in order to recognize when hormonal imbalance might
be the cause.
This lab will present some signs and symptoms and ask you to do your own research to track
down likely endocrine dysfunctions as possible sources of the problems.
Go through this Endocrine System Case Study (links to an external site) quick tutorial that will
give you good advice on how to navigate and complete this case study.
Click to get a PDF version of the Mary Keeper Case Study (links to an external site).
Please enter the answers to all of the case study questions in the text boxes
provided below.
Dr. Nee decided that Mary was suffering from three different endocrine dysfunctions. Give
the names of three possible conditions that you have decided are likely.
Your answer:
Hyperparathyroidism, pituitary tumor, and hyperthyroidism. Hyperthyroidism because TSH
is low, among other things.
Question 2 --- 3 points
What additional diagnostic test(s) and/or result(s) would help you confirm your diagnosis and
why? Be sure to explain how each test result will help you confirm your diagnosis of
conditions you came up with for question 1.
Your answer:
Hyperparathyroidism: Imaging on kidneys, blood tests for calcium and PTH levels, and urine
tests for calcium levels, as that can also rule out the kidneys as cause of high calcium.
Pituitary tumor: Imaging of head to check for masses in brain, like an MRI or CT scan. If there
is a mass, a biopsy of the brain can see what type of tumor it is. Check hormone levels in the
blood and urine to see if any are increased or decreased. If any hormones are increased or
decreased that the pituitary gland secretes, and a tumor is present, likely a pituitary tumor.
Hyperthyroidism: Scan thyroid with radioiodine to help decide between a goiter and Graves’
disease. Test TRH due to TSH being low. Test for antibodies against thyroid receptor.
Question 3 --- 12 points
Here is a quick summary of Mary’s blood values that were not in normal ranges:
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Blood Osmolality: Decreased
Calcium: Increased
T3 and T4: Increased
TBG: Decreased
TRH: Decreased
TSH: Decreased
TSI: Increased
ACTH: Decreased
PTH: Increased
LH: Increased
Estrogen: Increased
FSH: Increased
GHrH: Increased
GH: Decreased
GnRH: Decreased
Start with the first one in this list and explain why it is high or low. Do this for all the items in
the list. We are looking to see if you can use the pathophysiology of the conditions you came up
with to explain all of the blood lab values.
Your answer:
Blood osmolarity is low due to excessive diarrhea and water intake.
Calcium is high due to the PTH levels stimulating bone osteoclast.
T3 and T4 – increased due to increase thyroid activity, TSI antibody stimulation.
TBG is decreased because T3 and T4 are bound to it.
TRH is low because despite thyroid hormone levels being high, the hypothalamus doesn’t secrete
enough TRH.
TSH is low because of the negative feedback loop from excess thyroid hormone.
TSI is high because possible Graves’ disease raises TSI levels because it destroys proper balancing
receptors.
ACTH is low because tumors associated with gonadatroph usually results in hypopituitarism and
the surrounding cells could atrophy.
PTH is high because parathyroid activity is excessive.
LH is high because of the potential pituitary tumor, thus gonadatroph cells hyper-secrete.
Estrogen is high because of the LH. It controls the estrogen increase from the ovaries.
FSH is high because of the possible pituitary tumor, and hypersecretion of gonadatroph cells
GHrH is high because because of the increase in thyroid hormone, resulting in emotional or
physical stress.
GH is decreased because gonadatroph tumors can result in hypopituitarism and atrophy of cells
surrounding it.
GnRH is decreased because high FSH and LH inhibit GnRH.
Question 4 --- 3 points
Come up with a rationale to explain Mary’s headaches. Be sure to explain your rationale.
Your answer:
My first guess would be a tumor. As I mentioned before, if she has a tumor of the pituitary
gland, that would trigger all sorts of cranial nerves, which could cause headaches. Also, a
literal mass in the brain means everything around it is stretching to accommodate the space it’s
taking up, like the dura matter for example. Since she also has vision issues, that is a common
cause of headaches.
Question 5 --- 2 points
Provide a good rationale to explain Mary’s particular vision complications. Be sure to explain
your rationale.
Your answer:
In the case of the tumor, if it puts any pressure on the optic nerve then that would displace the
eye (laterally) and affect her vision, specifically peripheral vision, hence the bitemporal
hemianopsia.
Question 6 --- 2 points
Provide a good rationale as to why Mary’s blood osmolality is the value that it is.
Your answer:
She drank a ton of water, so that would decrease blood osmolarity. The tumor could also be
increasing the release of ADH. Excessive sweating and diarrhea would also play a part.