Assignment: Endocrine Disorders Knowledge Check

 Assignment: Endocrine Disorders Knowledge Check

Assignment: Endocrine Disorders Knowledge Check

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 daughters 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.

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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 

SIADH is characterized by less than maximally dilute urine in individuals with serum hypo-osmolality, usually in patients with normal thyroid, adrenal, hepatic, renal, and cardiac function with no volume depletion, hypotension, or other physiologic causes of vasopressin secretion.  Inappropriate ADH secretion is caused by various central nervous system disorders, certain cancers, and pulmonary disorders like tuberculosis and pneumonia (Mentrasti et al., 2020). Some medications are also associated with inappropriate ADH secretion like opioids, NSAIDs, Metformin, carbamazepine, antipsychotics, Prostaglandin synthetase inhibitors, SSRIs venlafaxine, and cytotoxics. The patient’s emphysema and current drug therapy with aspirin, escitalopram, and Metformin may have led to 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.

Polydipsia or increased thirst occurs in DM because of elevated blood glucose that increases blood osmolarity making it more concentrated. The increased osmolarity leads to a high osmotic dieresis that leads to excretion of electrolytes, like sodium, potassium, and chloride, through urine (Galicia-Garcia et al., 2020). The glucose-induced urination leads to increased urination. This causes severe water loss and dehydration that causes increased thirst leading to high water intake and resultant increased urination. In addition, inadequate insulin in Type 1 DM leads to glucose failing to enter body cells to be used for energy (Galicia-Garcia et al., 2020). As a result, the body cells starve leading to excessive hunger and increased appetite as they body continually craves for more glucose.

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.

Type 1 DM is a chronic metabolic condition characterized by autoimmune destruction of insulin-producing pancreatic islet beta cells in genetically predisposed persons. Yahaya & Salisu (2020) found more than 73 genes which were suspected in the pathogenesis of T1DM. The genes that accounted for most of the T1DM cases include the insulin gene, human leukocyte antigen (HLA), and cytotoxic T lymphocyte-associated antigen 4. The mutations in these genes, in addition to environmental factors, can result in a defective immune response in the pancreas, causing insulin deficiency, β-cell autoimmunity, and hyperglycemia. The mechanisms causing the cellular reactions are usually gene-specific and, if targeted in diabetic patients can result in improved treatment.

Question 4

4 pts

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? 

Type 2 diabetes is a heterogeneous disorder where insulin resistance occurs, and the beta cells lack the ability to overcome this resistance. Galicia-Garcia et al. (2020)explain that Type 2 DM is caused by a combination of two factors: impaired insulin secretion by pancreatic β-cells and the inability of insulin-sensitive tissues to respond to insulin secretion. In the case of impaired β-cell function, the body experiences decreased insulin secretion, which limits its ability to maintain physiological glucose levels (Galicia-Garcia et al., 2020). On the other hand, an impairment of the feedback loops between insulin secretion and action causes abnormally elevated glucose levels in blood, resulting in hyperglycemia and eventually Type II DM.

Question 5

4 pts

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 96.4ËšF, pulse 58 and regular, BP 106/92, 12 respirations. Dull facial expression with coarse facial features. Periorbital puffiness noted.

Diagnosis: hypothyroidism.

Question:

What causes hypothyroidism?

Hypothyroidism is caused by various factors including deficient hormone synthesis,

Congenital thyroid defects, Prenatal and postnatal iodine deficiency, and Autoimmune diseases like Hashimoto disease and sarcoidosis (Hegedüs et al. 2022). It is characterized by decreased levels of thyroid hormones (T3 and T4), which causes a slow basal metabolic rate (BMR). The decreased BMR affects lipid metabolism resulting in increased cholesterol and triglyceride levels.

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References

Galicia-Garcia, U., Benito-Vicente, A., Jebari, S., Larrea-Sebal, A., Siddiqi, H., Uribe, K. B., Ostolaza, H., & Martín, C. (2020). Pathophysiology of Type 2 Diabetes Mellitus. International journal of molecular sciences, 21(17), 6275. https://doi.org/10.3390/ijms21176275

Hegedüs, L., Bianco, A. C., Jonklaas, J., Pearce, S. H., Weetman, A. P., & Perros, P. (2022). Primary hypothyroidism and quality of life. Nature Reviews Endocrinology, 18(4), 230-242. https://doi.org/10.1038/s41574-021-00625-8

Mentrasti, G., Scortichini, L., Torniai, M., Giampieri, R., Morgese, F., Rinaldi, S., & Berardi, R. (2020). Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH): Optimal Management. Therapeutics and clinical risk management, 16, 663–672. https://doi.org/10.2147/TCRM.S206066

Yahaya, T., & Salisu, T. (2020). Genes predisposing to type 1 diabetes mellitus and pathophysiology: a narrative review. Medical Journal of Indonesia, 29(1), 100-9. https://doi.org/10.13181/mji.rev.203732