Leona McGill: Lab Tests
NOTE: Remember that unnecessary laboratory testing wastes precious time and increases health costs for all of us!
Laboratory test results:
- Electrolytes normal
- T3, T4, & TSH normal
- 24-hour urinary free cortisol: 157 mcg/24 h (normal 10-100 mcg/24 h)
- Serum glucose: 220 mg/dL (normal 64-128 mg/dl)
- Plasma ACTH: 140 pg/ml (normal 15-100 pg/ml)
- Plasma cortisol test
8 a.m. 88 mg/dL (normal 6-28 mg/dl)
4 p.m. 78 mg/dl (normal 2-12 mg/dl) - hCG negative
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Questions:
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- Your name:
- Email address:
- 1. What conditions do these results rule out?
- negative hCG?
- normal TSH, T3 & T4?
- 2. Cortisol is produced by the __________ and affects ___________.
- adrenal cortex ... glucose metabolism
- adrenal medulla ... energy production
- pituitary glands ... the adrenal glands
- thyroid glands ... cellular metabolism
- 3. T3 & T4 are produced by the _________ and function to ___________.
- adrenal cortex ... decrease cortisol levels.
- adrenal medulla ... raise cortisol levels
- pituitary glands ... stimulate the thyroid gland
- thyroid glands ... increase cell metabolism
- 4. ACTH is produced by the ___________ and acts to _____________.
- adrenal cortex ... increase cortisol production in the adrenal medulla.
- adrenal medulla ... decrease hormone production in the thyroid glands.
- pituitary gland ... increase cortisol production in the adrenal cortex.
- pituitary gland ... decrease cortisol production in the adrenal medulla.
- 5. TSH is produced by the __________ and acts to ______________.
- adrenal cortex ... increase cell metabolism.
- pituitary gland ... decrease hormone production by the thyroid gland.
- pituitary gland ... stimulate the thyroid gland to produce hormones.
- thyroid glands ... increase cell metabolism.
- 6. Elevations in which hormone level would directly account for Mrs. McGill's increased glucose?
- ACTH
- Cortisol
- T3 & T4
- TSH
- 7. What is the relationship between Mrs. McGill's increased ACTH, cortisol, and glucose levels?
- 8. One of the four hormones is associated with abnormal collagen production. Which hormone is it? Review your physical exam notes. Which of Mrs. McGill's signs can be explained by insufficient collagen?
- 9. What is the probably diagnosis for Mrs. McGill?
- 10. What are three etiologies for this condition? Which one is probably causing Mrs. McGill's condition? Bonus point: What tests would confirm your answer?
- 11. How can her condition be treated?
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