Endocrine Case Histories - Case 27

A 45-year-old male from the Midwest presented with the following symptoms during February: weakness, fatigue, orthostatic hypotension, weight loss, dehydration, and decreased cold tolerance. His blood chemistry values follow:
Serum sodium 128 mEq/L
Serum potassium 6.3 mEq/L
Fasting blood glucose 65 mg/dL
BUN 4.5 mg/dL
Serum creatinine 0.5 mg/dL

Hematology tests resulted in the following values:
Hematocrit 50%
Leukocytes 5000/cu mm
He also noticed increased pigmentation (tanning) of both exposed and nonexposed portions of the body and back. A plasma cortisol determination indicated a low cortisol level. Following administration of ACTH, plasma cortisol did not rise significantly after sixty and ninety minutes. Endogenous circulating levels of ACTH were later determined to be significantly elevated.

1a. What endocrine organ is the site of the malfunction?

1b. Is this a primary or secondary disturbance?

2. What is the name of this disorder?

3. Discuss the electrolyte disturbances resulting from this disorder.

4. Discuss the metabolic disturbances resulting from this disorder.

5. What is the cause of the tanning?

6. What type of replacement therapy would be required for this individual?

7. Describe the feedback loop for this endocrine disorder.

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