Somali Medical Forums
Medical Student Forums => Questions, Exams & Study tips => Topic started by: Malik on March 03, 2011, 07:08:25 PM
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A 60 year old South Asian woman with a one year history of lethargy and anorexia, and 3 kg weight loss was referred by her general practitioner to a medical outpatient department. Medical history included pulmonary tuberculosis, hypothyroidism, psoriasis, and Raynaud?s phenomenon. She was taking levothyroxine 100 μg daily, amlodipine 5 mg daily, and applying Polytar liquid 250 ml twice weekly to her scalp.
Clinical examination was unremarkable. Chest radiograph, abdominal ultrasound, and serum tissue transglutaminase antibodies, glucose, and thyroid function tests excluded active tuberculosis, coeliac disease, diabetes mellitus, and thyroxine overtreatment. Apart from persisting mild hyponatraemia (serum sodium concentration 128-135 mmol/L), routine haematology, biochemistry, and serum inflammatory markers were normal. The patient was not oedematous or dehydrated. Further investigations showed:
Serum sodium concentration 126 mmol/L (normal range 135-145 mmol/L)
Serum potassium concentration 4.1 mmol/L (3.5-5.0 mmol/L)
Serum urea concentration 6.9 mmol/L (1.0-7.0 mmol/L)
Serum creatinine concentration 79 μmol/L (60-120 μmol/L)
Serum glucose concentration 4.3 mmol/L (<6.1 mmol/L)
Serum osmolality 249 mmol/kg (275-295 mmol/kg)
Urine osmolality 469 mmol/kg
Urine sodium concentration 55 mmol/L
Thyroid stimulating hormone concentration 0.05 mU/L (0.27-4.20 mU/L)
Free thyroxine concentration 15.6 pmol/L (12.0-22.0 pmol/L)
Given these results, a short Synacthen test was performed using 0.25 mg Synacthen given intravenously at 0 minutes. ⇓
View this table:In this windowIn a new windowTable 1 Results of the short Synacthen test
Questions
1 What syndrome do the initial clinical findings and investigations suggest, and why was a short Synacthen test performed?
2 What diagnosis do the results of the short Synacthen test indicate, and how would you manage this condition?
3 After initiating treatment, the patient developed excessive thirst and polyuria associated with frequency and nocturia. Her plasma glucose concentration was 5.3 mmol/L. What is the significance of this?
4 What further investigations would you request?
5 In view of the new symptoms, how would you manage this patient?
REGARDS
MALIK
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hey, thanx for the question.. i can't see the synacthen test results.. did u upload them??
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Well brother Malik......I am not a medical student nor a doctor .......nor am I even an adult nurse....but I thought it might be interesting to see if I can come close to the answering at least one of your questions ....since it seems that nobody has attempt and hopefully ....some sweet soul will save me and help me answer it for me. Like mona ....I can not access the result table....then again I am not sure I be able to intepretate it anyhow. :)
The Asian lady has various problem already which can accelerate should she be in stress and stress can have strong effects on our body. From my nursing experience It seems that a short synacthen test is performed when they want to check the amount of cortisol in your body. We know that the adrenal glands increase their secretion of cortisol. Which mean the increase in cortisol inhibits the thyroid system by ,firstly, It decrease TSH secretion by the pituitary gland ...and from the test result you provided .....it showed a very low range of the Thyroid stimulating hormone concentration 0.05 mU/L (0.27-4.20 mU/L).Secondly it also decreases conversion of T4 to T3, I am wondering... with low T4. This is premature guess here .....mainly because this is beyond my depth....there is something called ?euthyroid sick? which is associated with rapid weight loss .....does this have any relevant to the case?
Give the lady some isotonic saline to correct her hyponatraemia :)
IKram
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Weight loss is the most burning issue in USA and at least one person in each family is worry about his body fats...
I think people should start doing more physical activities to burn their body fats..