BMedSci Y2: Adrenal gland SGT

Case 1

A 30 year old man goes to see a GP because he has been feeling gradually more
and more “out of sorts” and weak. The GP asks him about any other changes he has
experienced and reluctantly he begins to list a number of things he has noticed over
the previous three years. These include:

 A change in his body shape – his friends now call him “moony” because of the
shape of his face.
 He had to give up mountain-biking and switch to road-cycling because he had
broken so many bones and his skin gets wounded easily and the wounds
don’t heal very quickly and sometimes get infected
 He’s even finding it hard to cycle on the roads now, as he feels too weak to
get up the hills

The GP checks to see if the man is taking any medication long-term, but this is not
the case. He takes his blood pressure, which is rather high, and tests his urine for
glucose levels, which are also high. The GP suspects that the man has Cushing’s
syndrome, which is subsequently confirmed following specific tests.

Using your knowledge of the adrenal cortex answer the following questions:

1. Which hormone is the most affected and is it in excess or deficient in

Cushing’s syndrome?

2. What is the most common cause of Cushing’s syndrome?

3. What medications might the man have been taking long-term that could have
produced these signs and symptoms?

4. How does the hormone imbalance explain each of the symptoms that the man
reports?

5. Explain why the elevated blood pressure and urine glucose level are
consistent with the GP’s suspicions.

6. Whilst the man is waiting to have surgery to address the problem, what drug
might he be given to help reduce the impact of his symptoms in the
meantime?
Case 2

A 15 year old girl complains that her heart feels like it is “beating out of her chest”
sometimes even when she is resting. Her mother takes her to the GP who also finds
that she has abnormally high blood pressure for her age. Following referral to the
hospital she is diagnosed with phaeochromocytoma.

1. What is phaeochromocytoma?
2. How is it diagnosed?
3. Explain why the young girl was experiencing an elevated heart rate and blood
pressure
4. How can phaeochromocytoma be treated?