Endocrine Physiology Quiz, part 2

Quiz questions provided by Dr. Dominic L. Palazzolo, PhD Professor of Physiology, LMU-DCOM

Use the following scenario to answer questions 15 - 17.

Marge Simpson, a 30 year-old house wife, walks into your office. On examination you note that her skin is thick and dry, her hair is blue, she displays signs of alopecia, and she has an obvious goiter. Her movements appear to be sluggish and deliberate which indicate a low BMR. Since her last visit to your office, about a year ago, Mrs. Simpson has gained about 20 lbs, her mental acuity has diminished and she has a hoarse monotone voice. Lab results reveal that Mrs. Simpson has TSH levels of 94.3 mU/L (normal = 0.3 - 5.0 mU/L) and total thyroxine levels of 2.8 ug/dl (normal = 5 - 12 ug/dl).

15. What is the best diagnosis for Mrs. Simpson?

16. The best treatment option for Mrs. Simpson is __________.

17. The cause of Mrs. Simpson’s affliction was later determined to be thiocyanate (an agent found in the blue dye she uses in her hair). How does thiocyanate work to produce the signs and symptoms noted in the above scenario? Assume that thiocyanate is transported through the skin along with another lipid soluble agent found in the blue dye.

Use the following scenario to answer questions 18-20.

Peggy Hill, a 38 year-old house wife (and part time substitute Spanish teacher) walks into your office complaining of a urinary tract infection that she has not been able to reconcile for nearly three weeks. In addition, she complains of muscle weakness, weight gain, (particularly in the trunk region), unsightly purple markings across her abdominal region, and hyperpigmentation. Mrs. Hill also tells you that she has been experiencing amenorrhea for the past three months. On examination, her blood pressure was found to be 160/100 and her pulse was 98/minute. Hormone profiles revealed plasma cortisol levels were 52 ug/dl (normal = 5.25 ug/dl at 8:00 am) and plasma ACTH levels were 357 pg/ml (normal = < 80 pg/ml at 8:00 am). An MRI found a pituitary mass protruding up into the sella turcica. 

18. Mrs. Hill’s signs and symptoms are most consistent with __________.

19. What has most likely precipitated Mrs. Hill’s amenorrhea?

20. Mrs. Hill’s affliction could also lead to all the following conditions EXCEPT __________.

Use the following scenario to answer questions 21-23.

Bob and Miriam Pataki walk in to your office with their 16 year-old daughter Helga, who has not yet menstruated for the first time. Examination revealed a thin girl with normal breast development and the normal presence of pubic and axillary hair. On talking with Helga, you discover she is a junior in high school and is very active in sports. She is the highschool’s track and field star, and she is an avid swimmer. Because of her track practice, Helga stays up late most nights to do her homework, consequently, she only gets five to six hours of sleep a night.

21. The most likely diagnosis for Helga is __________.

22. Helga’s condition is described as _________.

23. The improper secretion of which of the following hormones do you suspect to be the original culprit of Helga’s amenorrhea?

Use the following scenario to answer questions 24-26.

Doug Funnie, a 16 year-old boy, collapsed in the school yard while talking to his girlfriend Patty Mayonnaise. When the paramedics arrive to take Doug to the emergency room, he is found to be mentally confused , profusely sweating, with a heart rate of 140/min. Blood pressure was 140/100. Patty told the paramedics that Doug has a history of type I diabetes and is on insulin therapy. At the hospital, lab results revealed that Doug’s glucose levels were 40 mg/dl (normal = 80 to 110 mg/dl) and insulin levels were 40 μU/ml (normal = 8 to 24 μ/ml).

24. What is the most likely cause for Doug’s hypoglycemia?

25. Hypoglycemia is known to cause increased secretion of many hormones. Which hormone listed below is most directly responsible for Doug’s profuse sweating and increased heart rate?

26. From the scenario above, Doug might also display __________.

Use the following scenario to answer questions 27-19.

Jay Sherman, a 56 year-old critic and the host of cable channel 67's "Coming Attractions” is referred to you by his dentist, who notices dental malocclusion and a slight protrusion of the jaw. Mr. Sherman complains of intermittent headaches and recent onset of polyuria and polydipsia. On examination he has clear enlargement of the hands and feet.

27. The most likely diagnosis for Mr. Sherman is _________.

28. Subsequent biochemical analysis reveals__________.

29. Which of the following hormones in Mr. Sherman’s hypothalamic-pituitary-hepatic axis would you expect to be decreased?

Use the following scenario for questions 30-32.

Didi Pickles, a 40 year old mother of two (Tommy and Dil), is admitted to the hospital with a large life-threatening tumor of the pituitary. It is unclear if the tumor is of posterior pituitary or anterior pituitary origin, so the surgeon decides to remove the whole pituitary. The hypophysectomy was complete and successful.

30. Which of the following pituitary hormones would you expect to increase?

31. Without hormone replacement, which group of steroids would be LEAST affected?

32. Which of the following pathologies would Mrs. Pickles most likely experience?