A 21-year-old male visits with his family doctor at the urging of his parents when home for Spring Break. The parents are concerned because their son has lost a significant amount of weight. The young man is concerned because he is experiencing a heart rate of 120bpm while at rest and much higher when exercising. Additionally, his blood pressure averages 137/82 based upon four recordings. He has a recurring headache, tremors in his hands and suffers dyspnea.
This individual has been generally health for his entire life, eats a reasonably good diet and is very active, thus the above symptoms are concerning. Standard blood tests show normal levels of blood cells, however there is an elevated amount of metadrenalines (metabolite by-product of adrenaline) and the urinalysis also shows an elevated amount of metabolites of catecholamines. The physician then orders a 24-hour urine test where the patient collects urine at regular intervals for a 24-hour period. The patient is warned to avoid stimulants such as cocoa and caffeine during this time period. The results of this test confirm elevated metabolites of catecholamines. The physician suspects a condition called pheochromocytoma, which is a (usually) non-cancerous tumor of the adrenal gland. This tumor causes the excess secretion of catecholamines. To confirm this suspicion, the physician orders a specialized type of CT scan, called MBIG. This type of scan utilizes radioactive iodine as a contrast agent for visualization of masses as described above. A sample of MIBG results is shown below:
The MIBG confirms the presence of a tumor on the adrenal gland and the young man is scheduled for surgery to remove the mass. It is non-cancerous and he resumes his life. As a side note, current estimates are that only about 10% of adrenal tumors are cancerous.
4. Based upon your answers in #1, do you think that catecholamines would bind to extracellular or intracellular receptors in their target cells? Why? Describe how catecholamines would effect a cellular change inside their target cells based on where their receptors are located. Do you think that many of the body’s cells would be targets for these hormones? Why or why not? (3 pts)
4.Catecholamines bind to receptors on the surface of cells (extracellular) that comprises target organs. Catecholamines unlike the steroid hormones (which use receptors inside the target cells) cannot cross the cell membrane because of which they cannot use receptors inside the target cells as an example, epinephrine which is a catecholamine and water soluble, therfore can bind to extracellular receptors.
Hormones cause cellular changes by binding to a receptor on target cells, catecholamines bind to receptors on plasma membrane surface and trigers a signalling pathway to change the cells activity, the hormone which binds at surface remains at the surface of cell, while the intracellular product remains inside the cell, the hormone which initiates the signalling pathway is called first messanger, which activates second messanger in the cytoplasm, one important second messanger is the cyclic AMP (cAMP), when protien binds to its membrane receptor, G-protien is activated, when hormone is not bound to the receptor, G-protien is not active, when a hormones binds to a receptor G-protien is activated, the activated G-protien activates a membrane bound enzyme called adenylyl cyclase, which trigers cellular response. Cellular response to hormones include the production of protien, enzymes and altered membrane permeablity.
Many of the cells in our body would not be target for these hormones, the body's response to diffrent catecholamines depend on two major types of adrenergic receptors, alpha adrenergic receptors and beeta adrenergic receptors, in general activation of alpha adrenergic receptors results in vasoconstriction, contraction of uterine muscles, dilation of pupils etc and activation of beeta adrenergic receptors resultsa in vasodilation, increase in heart rate, dilation of bronchi, stimulation of cardiac contraction etc.
A 21-year-old male visits with his family doctor at the urging of his parents when home...
15. Benjamin, a 21-year-old male is brought to the emergency department by his parents will that he has not been himself for the past 18 hours. He is a college student who was home for the weekend complaining of headaches. The parents inform the physician that their son has no past medical history. They are not aware that he is taking any medication. History and physical findings per the physician are positive for headaches and altered mental status with a...
A 58-year-old male college professor sees his family physician because of increasing fatigue and weakness. He also reports pain in his lower back and arms when he walks. Physical examination reveals that the man has pale mucous membranes and hepatosplenomegaly. The physician orders a complete blood count (CBC) and urinalysis. A follow-up appointment is scheduled for the following week. Laboratory Data: The CBC reveals that the patient has anemia. His leukocyte count and differential count are normal, except for a...
A 21-year-old man presents himself to the release of information (ROI) specialist at Metro Medical Center with a request to access his birth records. The young man stated he was adopted and has recently experienced some health complications that his physician suspects are linked to a possible genetic disorder. If he can confirm whether a genetic disorder exists through his mother, the physician will be able to establish a more positive, less expensive, and evasive treatment protocol for the young...
As a home health nurse working with a newly diagnosed 17-year-old young man with schizophrenia who lives at home with his parents, you stop by to check on the patient at the request of his parents. The parents share their concerns that the patient’s medication, paliperidone (Invega), does not appear to be working as well as it had when the patient first started taking it. They report that the patient is more irritable; has an increase in his hallucinations with...
what is his diagnosis ? William, a 69-year-old retired male went to his doctor, complaining of leg pain that started in his lower back, ran across the side of his thigh and over the front of his knee. Next, he developed pain that radiated from his back to his front at the chest through the level of his nipples and also at the umbilicus. A physical and laboratory tests showed hard nodule on his prostate and an elevation in several...
Case Study – Chapter 21 Respiratory System Infectious A 35-year-old Hispanic man presented to his family physician with fever which had persisted over 4 days. He had no history of fevers lasting this long. He had contracted tuberculosis when he was 17, but he had no family history of TB. He had taken no medications. He was a smoker and occasionally drank alcohol. He described to his doctor that 2 days prior, he suddenly developed chills and a sore throat...
A 32-year-old male presents to your office for initial evaluation. He is a busy systems analysis for a computer manufacturer who travels a lot, and put in many hours of work with in adequate rest. He is mildly obese but continues to have a poor diet. He eats fatty foods and does not exercise, aside from when he is running late to an appointment. He snacks often I'm salty foods. For the past two months, he complained of feeling weak,...
Carl Vinson, a 65-year-old Caucasian man, was admitted today with increased shortness of breath, fatigue, and decreased level of consciousness. Mr. Vinson has a history of liver disease, most likely related to a long history of alcohol use. Upon arrival to the unit, he is somnolent and responds only to shouting and shaking. Upon arousal, he is only able to state his first name. His wife accompanies him to the unit, and describes that he has become increasingly restless over...
Please answer ALL of the following questions. 1. A) Which type of hormonal disorder is due to improper production or release of control hormones in the hypothalamus? B) Which type is due to improper release of the hormone by the peripheral target gland or organ? 2. You examine a patient presenting with excessive glucocorticoid levels, increased upper body obesity, a moon face and behavioral changes. A) Which condition would you suspect this individual has? B) What effect would this condition have on...
1. Dixon is a 43-year-old man with a family history of colon cancer. The physician has suggested that he perform a fecal occult blood test. However, when you discuss it with him he tells you that he is not interested because “there is nothing that can be done about colon cancer anyway.” He is referring to the fact that his father and his brother died of the disease. What should you say to him? 2. Jeffrey is a 15-year-old boy...