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Case 10 Patient A 35-year-old patient is complaining about rapid weight gain and
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A 35-year-old patient is complaining about rapid weight gain and excessive sweating. The major
reason why she is seeking medical help is because she recently experienced a panic attack. A
striking physical characteristic is that she has a swollen face when compared to the rest of her
body and muscle loss in the limbs. Also she has complaints about headaches, backaches,
irregular menstrual cycling, and feeling depressed. More recently, she also noticed that a bruise
was healing slowly.
Glucose tolerance: abnormal, consistent with insulin resistance
Plasma cortisol: 25 ug/dl at 4 pm (range 3 – 15 ug/dl)
Urine cortisol: abnormally high
Plasma ACTH: 7 pg/ml (range >20 pg/ml)
MRI: pituitary is normal
CT: abdominal: Adrenal tumor
1) Based on the laboratory tests, why was radiology focused on the pituitary and abdomen?
2) What is this disorder known as? How would you treat this patient?
3) Describe the normal physiological regulation of the cortisol? And explain the potential causes
of why ACTH level are lower than normal?
4) Describe the location and biochemical pathway of cortisol synthesis, and how cortisol affects
5) What is a dexamethasone suppression test, and why would you order such a test?
6) Explain how long-term hypercortisolism affects glycogen stores, plasma glucose levels, and
can cause abnormal glucose tolerance, leading to excessive weight gain and muscle loss.
7) Provide an example of other hormones that could affect the endocrine status of this patient?