Topic 6 DQ2
Select two of the following discussion questions for your discussion response. Indicate which
questions you have chosen using the format displayed in the "Discussion Forum Sample."
1.What symptoms and exam findings would prompt you to perform a pituitary workup? What
laboratory and neuroimaging studies would you order and why? P. 649
2.A 24-year-old postpartum patient presents with vague symptoms of fatigue, weight fluctuation,
brittle nails, and a lump in her throat. From an endocrine standpoint, what are your potential
diagnoses based on symptoms without knowing lab findings? Include the potential workup you would
attempt. p.681
3.What is the difference between diabetic ketoacidosis and hyperosmolar nonketotic syndrome? How
do the treatment options differ as well as have similarities? What are the associated conditions that
would cause either of the conditions? P. 693-694
“A 24-year-old postpartum patient presents with vague symptoms of fatigue, weight fluctuation,
brittle nails, and a lump in her throat. From an endocrine standpoint, what are your potential
diagnoses based on symptoms without knowing lab findings? Include the potential workup you would
attempt.”
ANSWER:
Based on the patient’s symptoms, I would diagnose her with postpartum thyroiditis. Postpartum
thyroiditis is an uncommon condition where a normal-functioning thyroid gland becomes inflamed
within the first year after childbirth (McCance & Huether, 2019). This can last several weeks-months
but is often mistaken for postpartum mood disorders due to the stress of having a newborn.
Symptoms happen in two phases; first phase is related to the inflammation and typically occurs 1-4
months after delivery and lasts 1-3 months. They may show signs of anxiety, irritability, rapid heart
beat or palpitations, unexplained weight loss, increased sensitivity to heat, fatigue, tremor, and
insomnia. The second phase is when the thyroid cells become impaired resulting in mild signs and
symptoms of underactive thyroid (hypothyroidism). Typically begin 4-6 weeks after the symptoms of
hyperthyroidism resolve and can last up to 6-12 months. These signs and symptoms include; lack of
energy, increased sensitivity to cold, constipation, dry skin, weight gain, and depression. Diagnosis
workup of postpartum thyroiditis consists of blood tests measuring the level of
thyroid-stimulating hormone (TSH) and level of the thyroid hormone thyroxine.
Reference:
McCance, K., & Huether, S. (2019). Pathophysiology: The biologic Basis for disease in adults and
children (8th ed.). St. Louis, MO: Mosby. ISBN-13: 9780323402811
“What is the difference between diabetic ketoacidosis and hyperosmolar nonketotic syndrome?
How do the treatment options differ as well as have similarities? What are the associated conditions
that would cause either of the conditions?”
ANSWER
Diabetic ketoacidosis (DKA) is a serious complication due to a deficiency of insulin and an increase in
the levels of insulin counterregulatory hormones; catecholamines, cortisol, glucagon, and growth
hormone (McCance & Huether, 2019). Counter-regulatory hormones normally antagonize insulin by
increasing glucose production and decreasing tissue use of glucose. When there is a profound insulin
deficiency, glucose uptake is decreased, increasing fat mobilization with release of fatty acids, and
accelerated gluconeogenesis, glycogenesis, and ketogenesis. DKA occurs in patients who have type 1
Diabetes mellitus (DM) due to the deficiency of insulin. Most common cause of DKA are intercurrent
illness’ such as infection, trauma, surgery, or myocardial infarction. The patient will have kussmaul
respirations in attempt to compensate for the acidosis, postural dizziness, central nervous system
depression, ketonuria, anorexia, nausea, vomiting, abdominal pain, and acetone odor on the breath,
dehydration, thirst, and polyuria. DKA is diagnosed by a serum glucose level >250mg/dL, serum
bicarbonate level <18, serum pH <7.3, presence of an anion gap, and the presence of urine and serum
ketones. Treatment involves insulin administration to decrease glucose levels, fluids to replace lost
fluids, and electrolyte replacement.
Select two of the following discussion questions for your discussion response. Indicate which
questions you have chosen using the format displayed in the "Discussion Forum Sample."
1.What symptoms and exam findings would prompt you to perform a pituitary workup? What
laboratory and neuroimaging studies would you order and why? P. 649
2.A 24-year-old postpartum patient presents with vague symptoms of fatigue, weight fluctuation,
brittle nails, and a lump in her throat. From an endocrine standpoint, what are your potential
diagnoses based on symptoms without knowing lab findings? Include the potential workup you would
attempt. p.681
3.What is the difference between diabetic ketoacidosis and hyperosmolar nonketotic syndrome? How
do the treatment options differ as well as have similarities? What are the associated conditions that
would cause either of the conditions? P. 693-694
“A 24-year-old postpartum patient presents with vague symptoms of fatigue, weight fluctuation,
brittle nails, and a lump in her throat. From an endocrine standpoint, what are your potential
diagnoses based on symptoms without knowing lab findings? Include the potential workup you would
attempt.”
ANSWER:
Based on the patient’s symptoms, I would diagnose her with postpartum thyroiditis. Postpartum
thyroiditis is an uncommon condition where a normal-functioning thyroid gland becomes inflamed
within the first year after childbirth (McCance & Huether, 2019). This can last several weeks-months
but is often mistaken for postpartum mood disorders due to the stress of having a newborn.
Symptoms happen in two phases; first phase is related to the inflammation and typically occurs 1-4
months after delivery and lasts 1-3 months. They may show signs of anxiety, irritability, rapid heart
beat or palpitations, unexplained weight loss, increased sensitivity to heat, fatigue, tremor, and
insomnia. The second phase is when the thyroid cells become impaired resulting in mild signs and
symptoms of underactive thyroid (hypothyroidism). Typically begin 4-6 weeks after the symptoms of
hyperthyroidism resolve and can last up to 6-12 months. These signs and symptoms include; lack of
energy, increased sensitivity to cold, constipation, dry skin, weight gain, and depression. Diagnosis
workup of postpartum thyroiditis consists of blood tests measuring the level of
thyroid-stimulating hormone (TSH) and level of the thyroid hormone thyroxine.
Reference:
McCance, K., & Huether, S. (2019). Pathophysiology: The biologic Basis for disease in adults and
children (8th ed.). St. Louis, MO: Mosby. ISBN-13: 9780323402811
“What is the difference between diabetic ketoacidosis and hyperosmolar nonketotic syndrome?
How do the treatment options differ as well as have similarities? What are the associated conditions
that would cause either of the conditions?”
ANSWER
Diabetic ketoacidosis (DKA) is a serious complication due to a deficiency of insulin and an increase in
the levels of insulin counterregulatory hormones; catecholamines, cortisol, glucagon, and growth
hormone (McCance & Huether, 2019). Counter-regulatory hormones normally antagonize insulin by
increasing glucose production and decreasing tissue use of glucose. When there is a profound insulin
deficiency, glucose uptake is decreased, increasing fat mobilization with release of fatty acids, and
accelerated gluconeogenesis, glycogenesis, and ketogenesis. DKA occurs in patients who have type 1
Diabetes mellitus (DM) due to the deficiency of insulin. Most common cause of DKA are intercurrent
illness’ such as infection, trauma, surgery, or myocardial infarction. The patient will have kussmaul
respirations in attempt to compensate for the acidosis, postural dizziness, central nervous system
depression, ketonuria, anorexia, nausea, vomiting, abdominal pain, and acetone odor on the breath,
dehydration, thirst, and polyuria. DKA is diagnosed by a serum glucose level >250mg/dL, serum
bicarbonate level <18, serum pH <7.3, presence of an anion gap, and the presence of urine and serum
ketones. Treatment involves insulin administration to decrease glucose levels, fluids to replace lost
fluids, and electrolyte replacement.
