Table 1: Prolonged hormone hypersecretion and the subsequent effects on hormone negative feedback loops.
TRH
TSH
ACTH
Cortisol
Testosterone
LH
GHRH
GH
Organs in Feedback Loop
Hypothalamus
Anterior Pituitary
Thyroid Gland
Testes
Adrenal Glands
Target Tissues and Outcomes
Thymus
Adipose Tissue
abd:
ext:
Skeletal Muscle
Bone
( - )
( - )
Body Weight
*abd = abdomen
*ext = extremities
Patient 1: 42-year-old male
Patient History- This patient came in with a large abscess on his leg. He stated that over the past few months he had experienced several infections and 4 colds. His physical exam showed that he has high blood pressure, acne, weight gain in the midsection and upper back, and a “moon face.” A bone scan showed osteoporosis and an MRI showed a gray spot adjacent to the anterior pituitary.
His blood panel showed:
Blood, Plasma, Serum
Patient Profile
Reference Range
Adrenocorticotropic hormone
300
9-52 pg/ml
Cortisol
297
Morning: 6-23 mcg/dl
Glucose, serum
190
Fasting: 60-100mg/dl
Growth Hormone Releasing hormone
3
Fasting: <5 ng/ml
Growth Hormone, serum
5
Fasting: <5 ng/ml
Luteinizing Hormone, serum/plasma
20
6-23 U/L
Testosterone
600
300-1000 ng/dl
Thyroid stimulating Hormone
6
2-10 mU/L
Thyroxin (T4) serum
8
5-12 ug/dl
Triglycerides
180
35-160 mg/dl
Options for diagnosis:
Anterior pituitary overproducing ACTH
A tumor in the adrenal gland causing the overproduction of Cortisol
An ectopic ACTH secreting tumor (Rarely, when a tumor develops in the lungs, pancreas, the thyroid or the thymus, the tumor will begin secreting ACTH)
Hypothyroidism
Patient 2: 46-year-old male
Patient History: The man came in complaining of uncontrolled weight gain in his abdomen and back. He complained that his wife was calling him “Igor” because of the fat hump growing on his back. His physical exam showed he has high blood pressure, acne, muscle weakness, and a small mass on his thyroid. An MRI showed a small anterior pituitary.
His blood panel showed:
Blood, Plasma, Serum
Patient Profile
Reference Range
Adrenocorticotropic hormone
300
9-52 pg/ml
Cortisol
297
Morning: 6-23 mcg/dl
Glucose, serum
190
Fasting: 60-100mg/dl
Growth Hormone Releasing hormone
3
Fasting: <5 ng/ml
Growth Hormone, serum
5
Fasting: <5 ng/ml
Luteinizing Hormone, serum/plasma
20
6-23 U/L
Testosterone
600
300-1000 ng/dl
Thyroid stimulating Hormone
6
2-10 mU/L
Thyroxin (T4) serum
8
5-12 ug/dl
Triglycerides
180
35-160 mg/dl
Options for diagnosis:
Anterior pituitary overproducing ACTH
A tumor in the adrenal gland causing the overproduction of Cortisol
An ectopic ACTH secreting tumor (Rarely, when a tumor develops in the lungs, pancreas, the thyroid or the thymus, the tumor will begin secreting ACTH)
Hyperthyroidism
Patient 3: 32-year-old male
Patient History: A construction worker came in complaining that he could not tolerate the summer heat this year. It had never bothered him in previous years, but this year was different. His physical exam showed he had hair loss, a rapid heart rate, and had lost...
