Part 1: Renal Disorders
This involves Renal Disorders. For someone in untreated renal failure , list what types of alterations one would see for the following (including rationale why it would be altered in that way).
- Hematocrit
- Potassium
- Calcium
- Phosphate
- pH
- Creatinine
Part 2: Endocrine Hormone and Feedback:
For each of the following, assume that enough time has passed that feedback loops would be active (if applicable).
1. You are taking care of a 46 year old routine post-hysterectomy patient, and you have just reviewed some very interesting lab work on her. Here it is:
– Serum sodium high (hypernatremia)
– Urine sodium low
Based on that lab work, you decide (wisely) to walk in to her room and take a look at what?___________________
That’s right! You want to look at her urine! You see a very large amount of light clear yellow urine in her foley.
You scratch your head and wonder. Which of the following would MOST LIKELY be the cause of this? (This obviously does not have anything to do with hysterectomy, so don’t get off track studying that).
A. An autoimmune process in a patient’s posterior pituitary gland leading to Diabetes Insipidus
B. A tumor pressing on the anterior pituitary gland leading to Addison’s
C. A traumatic event in the adrenal gland leading to Cushings
D. A tumor in the thyroid gland leading to Hyperthyroidism
E. Based on the data given above, why do you know that this would NOT likely be due to over-hydration from say a lot of IV fluid or something like that?
2. A neurogenic event in your patient post-stroke has just caused the thyroid gland to become hypoactive. The anterior pituitary gland and the hypothalamus were not affected. What would you expect to see for the following?
T3_________
T4_________
TSH________
TRH________
Explain your rationale below. Include discussion of the feedback loops and how those function.
3. A medication-induced condition in your patient with emphysema has just caused a problem in the adrenal gland and has caused it to become hyperactive. The anterior pituitary gland and the hypothalamus were not affected. What would you expect to see for the following?
T3______
T4______
TSH_____
TRH_____
Cortisol_________
Aldosterone______
Androgens_______
ACTH__________
CRH____________
4. A patient has tumor-induced increased functioning of the anterior pituitary gland. In this patient this is then affecting the adrenal gland. The hypothalamus has normal functioning ability. List whether each of the following are normal, elevated, or decreased.
Cortisol________
Aldosterone_______
Androgens________
ACTH___________
CRH____________
Explain your rationale below. Include discussion of the feedback loops and how those function.
5. Fill in the table below to answer this question. What are the differences (if any) between the following two conditions (what you would see for each — fill in table below)?
A). A tumor in the hypothalamus suppresses ALL hormones/factors released from the hypothalamus.
B). A tumor pressing on the entire pituitary gland which suppresses ALL hormones coming from the entire pituitary gland (anterior and posterior glands) but the hypothalamus functions fine.
List below what this means for each of the following (would they be normal, elevated, or decreased) and what symptoms you might expect to see for each:
| Lab: | Increased, Decreased, or Normal? | What symptoms? | |
| Condition A | T3, T4 | ||
| TSH | |||
| TRH | |||
| Cortisol, aldosterone, androgens | |||
| ACTH | |||
| CRH | |||
| ADH | |||
| Condition B | T3, T4 | ||
| TSH | |||
| TRH | |||
| Cortisol, aldosterone, androgens | |||
| ACTH | |||
| CRH | |||
| ADH |
