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Endocrine Case Study
Don Smart, 55 years of age presents to the family physician to follow up on some symptoms he recently
developed. The patient states that he is extremely tired and is having trouble concentrating. He states
that his skin is dry and flaky. His nails are brittle and his hair is dry, dull, and falls out as he showers. He is
8 weeks postop after a modified radical neck procedure for laryngeal cancer and has completed the
external radiation therapy. He is using a Blom–Singer prosthesis for speech. He states that his appetite is
poor, yet he is gaining weight. The patient’s current medications include metformin (Glucophage) for a
history of type 2 diabetes, digoxin 0.25 mg every day for a history of atrial fibrillation, and warfarin
therapy being managed by the family physician for thromboembolism prophylaxis related to atrial
fibrillation. The physician orders the following lab work: CBC with differential, serum albumin, TSH, FT4,
PT, and INR.
1. This patient is showing signs dealing with his thyroid. Would you say this patient is experiencing
signs of hypothyroidism or hyperthyroidism?
2. What are signs of hypothyroidism?
3. What are signs of hyperthyroidism?
4. What is another name for hyperthyroidism?
5. What is the rationale for the labs ordered?
6. What medication is given to treat hypothyroidism?
7. What education would you give this patient about hypothyroidism?
Mrs. Ramirez was admitted to the hospital for wrist surgery secondary to
rheumatoid arthritis. Postoperatively, she is stabilized and transferred to the
general surgery unit. Mrs. Ramirez’s medications include digoxin, Lasix, captopril,
Synthyroid, aspirin, Protonix, and prednisone. When administering morning
medications, Mrs. Ramirez refuses her aspirin and prednisone, and the nurse holds
the medications. Over the next 3 days, Mrs. Ramirez continues to refuse the
prednisone, and the medication is not administered. On the third postoperative day,
Mrs. Ramirez becomes hypotensive, tachycardic, and has a decrease in level of
consciousness. STAT labs are sent for a complete blood cell count and chemistry
panel, and the physician is notified of the change in patient status. On review of the
patient’s record, the physician notes that Mrs. Ramirez has not received her
prednisone for 4 days. Mrs. Ramirez has been on Prednisone for the past 5 years
for her rheumatoid arthritis, and the physician begins to treat the patient for acute
adrenal insufficiency.
1. What are the purposes of the adrenal glands?
2. What hormones to do the adrenal glands produce?
Endocrine Case Study
3. When I have an overproduction of adrenal gland hormones what is the disease called?
4. When I have an underproduction of adrenal gland hormones what is the disease called?
5. What is the disease called with low production of adrenal hormones?
6. What is the disease called with high production of adrenal hormones?
7. What are symptoms of Addison’s disease?
8. What are symptoms of Cushing’s disease?
9. What is the treatment for Addison’s disease?
10.What is the treatment for Cushing’s disease
11.What is addison’s crisis? And why does it happen?

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