NATIONAL CENTER FOR CASE STUDY TEACHING IN SCIENCE
“Living the Sweet Life” by Breanna N. HarrisPart II – Mary SmithCarefully inspect the test results below and use the information together with what you learned from Part I to diagnose the patient and answer the following questions
Smith, M. Lab Results – Dr. Gupta, M.D.TestResultNormal RangeRandom blood sugar (mg/dl)155< 140Fasting blood sugar (mg/dl)11075–105GTT glucose at 2 hr180< 200Fasting morning cortisol (ug/dl)285–23DEX challenge cortisol (ug/dl)27< 5DEX challenge ACTH (pg/ml)100<10Hemoglobin A1c %6< 6.5c-peptide (ng/ml)1.30.5 to 2Antibodies against pancreasnormalnormalTestosterone (ng/dl)9015–75Non-ovulatory estrogen (pg/ml)4540–50Urinary glucose (ug/dl)150–15T3 (ng/dl)17580–180T4 (ug/dl)104.6–12DEX Challenge: Mary was given 1 mg of DEX at 11 PM and then a blood sample was collected at 8 AM for analysis of cortisol and ACTH.MRI Results: Mary’s brain MRI was clear but the MRI of her body showed lumps in her peritoneal cavity.
Questions
What would you expect DEX to do to Mary’s ACTH and cortisol levels?
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?TimeCortisol Level (ug/dl)ACTH (pg/ml)Fasting morning28—9-hr post DEX27100
What diagnosis do the baseline and post-DEX results suggest?
What are the results of Mary’s MRI scan? What does this tell you about Mary’s HPA axis?
What is your specifi c diagnosis for Mary? Which data support this?
What treatment would you recommend for this patient?