Case Study 1
1. What hormonal problem could be causing these symptoms?
His pituitary gland isn’t working because it has a tumor on it causing his problems like bad coordination, being very tall and skinny (6ft, 150lbs, and size 13 shoe), right knee swelled, ulcerated sores on lower left leg that wouldn’t heal, often was sick and didn’t feel good, and having large hands and feet.
2. Why would joint damage be associated with rapid growth and low testosterone levels?
Joint damage would be associated because of the growing pain that a person has when having a growth spurt. His bones and ligaments were stretching quicker than a normal person would stretch and his joints can’t keep up with it causing the joint pain. Low testosterone levels can’t ossify the plates. ACTH controls cortisol, so if he doesn’t have it, it will affect how much is released.
1. Should Dr. Kidd tell Eric that he is probably sterile? Why would he be sterile?
Dr. Kidd should tell Eric that there is a possibility of him being sterile and that they can run tests to confirm if he is correct or not. Eric would be sterile because if he does have a pituitary problem his FSH (makes sperm) and LH (develops sperm) levels wouldn’t making him sterile.
2. Is there anything that they could try to do to stimulate spermatogenesis? Why is the absence of facial hair important?
They could give Eric hormones (FSH & LH) to try to help stimulate spermatogenesis. The lack of facial hair tells doctors that Eric is not producing gluttonizing hormones.
1. Why was he growing facial hair?
Eric began growing facial hair because he was given a hormone called human chorionic gonadotropin (hCG) for two years in an attempt to produce sperm and his secondary sex hormones.
2. Why did he need jaw surgery?
Eric needed jaw surgery because his jaw had been hurting, especially the joint on the left side. The dentist thought he had TMJ (temporal mandibular joint dysfunction) and referred him to a dental surgeon who proceeded with the surgery. His upper jaw stops growing and his lower jaw keeps growing. They broke the lower jaw because they are trying to preserve his trigeminal nerve. The surgery did get rid of the frequent headaches that Eric was having.
1. Why are his kidneys so active at night?
His kidneys were so active at night because his antidiuretic levels (found in the posterior pituitary) were damaged causing him to release water all the time instead of having the kidneys keep some. The hypothalamus was releasing ADH when he was younger, but as he got older it stopped releasing it.
2. It also turns out he has unpredictable shock responses, so that a small cut needing three stiches left him pale and in shock while breaking his left wrist in 15 places did not. What hormone could be involved?
The hormone that might be involved would be ACTH. The anterior pituitary controls the adrenal gland and it doesn’t have epinephrine and norepinephrine for stress response- no check and balance system.
3. If the pituitary is so important, and if Eric id not getting replacements of hormones the pituitary makes (except for ADH), why isn’t he dead?
The hypothalamus controls the regulation of the pituitary glands hormones. The hypothalamus is compensating because it is releasing some of the hormones into the bloodstream.