Abstract – Part 1
A 15 year old patient is presented with right knee swelling, ulcerated sores on his lower left leg, large hands and feet, low cortisone levels, low testosterone levels, high growth hormone levels and a frequency of not feeling good. Patient is 6 feet tall and 150 lbs.
What hormonal problem could be causing these symptoms?
The patient’s symptoms of large hands and feet, low thyroid activity, low cortisone levels, low testosterone levels, high growth hormone levels and are caused by an endocrine gland problem. His low cortisone, low testosterone and high growth hormones show that he is having issues within his anterior pituitary gland.
Why would joint damage be associated with rapid growth and low testosterone levels?
Joint damage is associated with rapid growth and low testosterone levels due to the testosterone not being able to keep up with maintaining the bone density, while rapid growth causes a decrease in blood supply to the cartilage.
Abstract – Part 2
Patient is now 25 years old and has been diagnosed with a benign pituitary tumor. The tumor was putting pressure on the pituitary and disrupting its normal functions. The patient received irradiation to kill the pituitary and tumor. He also received a cartilage operation on his knee, with metal pins in both hips to hold the joint together. The patient’s hormone levels have since stabilized and he will need to be on replacement hormones for life. Patient is now 6’4″ and 220 lbs.
Should Dr. Kidd tell Eric he is probably sterile? Why would he be sterile?
The doctor should inform his patient that there is a high chance he may be sterile. The patient would be sterile due to his pituitary gland not producing the hormones needed during puberty in his teens for spermatogenesis.
Is there anything that they could try to do to stimulate spermatogenesis? Why is the absence of facial hair important?
hCG injections could stimulate spermatogenesis. The absence of facial hair is important because it is a sign that the patient did not produce enough testosterone during puberty to fully develop secondary sex characteristics and sexually mature.
Abstract – Part 3
Patient is now 28 years old and has grown two inches in two years while undergoing hCG injections to stimulate spermatogenesis, which did not succeed. Patient is now 6’6″ and weighs 275 lbs. Patient underwent surgery to expand his jaw as treatment for pain due to TMJ.
Why was he growing facial hair? Hint: hCG acts like FSH and LH, which are pituitary hormones that trigger a variety of sexual developments and secondary sexual characteristics, whereas testosterone is more of an end-level hormone.
The patient began growing facial hair because of hCG injections. Due to hCG acting like FSH and LH, which are produced during puberty in a typical teen, the injections caused his body to go through puberty at a much later age.
Why did he need jaw surgery?
The patient’s dentist thought he might have TMJ (temporomandibular joint dysfunction). This is possibly due to the high growth hormones in his teens causing certain bones to grow more than others.
Abstract – Part 4
Patient is now 45 years old and is now presenting that he is not sleeping due to frequent nighttime trips to the bathroom. The patient is now 6’6″ and 310 lbs.
Why are his kidneys so active at night? Note: diabetes insipidus is not diabetes mellitus, so the answer is not high blood sugar levels or an insulin deficiency. Diabetes merely means high urine production. Look for specific hormonal problem involving the pituitary.
The patient’s kidneys are active at night due to his antidiuretic hormone (ADH) levels being damaged. ADHs help conserve water and is found in the posterior pituitary. Due to the damage to this hormone, his kidneys were releasing water at all times. It appears that he has acromegaly due to his high growth hormone levels.
It also turns out that he has unpredictable shock responses, so that a small cut needing three stitches left him pale and in shock while breaking his left wrist in at least places did not. What hormone could be involved?
Cortisone is the hormone involved in shock responses. Due to his low cortisone levels, the adrenal gland is not able to work with the pituitary gland as it properly should. This causes the steroids that the adrenal gland produces to not be released during certain events, such as during a small cut needing three stitches.
If the pituitary is so important, and if Eric is not getting replacements of hormones the pituitary makes (except for adh), why isn’t he dead? To answer this question, think through the cascade of events from hypothalamus to effect.
The patient can live without the pituitary gland as long as he is on replacement hormones for those that are controlled by the pituitary. Living on replacement hormones guarantees life, but it does not guarantee a normal, healthy life. The hypothalamus will also step in to compensate for releasing some hormones into the bloodstream.