230 lbs later...

Answer to Mystery Diagnosis #6:

Cushing’s Syndrome

Cushing syndrome is a hormone disorder caused by prolonged exposure of the body’s tissues to high levels of cortisol.  Cortisol is produced by the adrenal gland and is a steroid hormone that helps the body react to physical and emotional stress, metabolize food, and regulate blood pressure. 

Many people can develop Cushing’s because of glucocorticoids, steroid hormones that are chemically similar to cortisol.  People take glucocorticoids to treat asthma, rheumatoid arthritis, lupus, and other inflammatory diseases.  Other people develop Cushing’s because their body produces too much cortisol or by tumors that produce cortisol or adrenocorticotropic hormone (ACTH) or corticotropin-releasing hormone (CRH). 

Signs and Symptoms:

·         Weak muscles

·         Changes in the skin (such as skin that is oily and frail)

·         Changes in mood (such as irritability, anxiety, and depression)

·         Extra fat on back of neck and upper back (buffalo hump)

·         Backaches

·         Loss of muscle tone

·         Hair loss

·         Hair growth that is not normal (such as facial hair in women)

·         High blood pressure

·         High blood sugar levels

·         Obesity (weight gain located on abdomen)

·         Bone loss

·         Headache

Detection:

Cushing’s syndrome can be difficult to diagnose.  A cortisol test, which may be done on a blood or urine sample, is the easiest form to detect Cushing’s. 

Treatment:

Treatment of Cushing’s Syndrome depends on the cause. 

·         Reducing corticosteroid use

·         Surgery (to remove tumor)

·         Radiation therapy

·         Medications: Nizoral, Lysodren, and Metopirone

In Charlotte’s case she had a tumor in her pituitary gland that was causing overproduction of ACTH.  Charlotte saw an Endocrinologist that did blood tests and detected her tumor.  Her tumor was removed and Charlotte has returned to normal, losing about 40 lbs so far. 

Cushing’s syndrome is an extremely rare; an estimated at 13 cases per million individuals.  Cushing’s affects adults between the ages of 20 to 50. 

Works Cited: 

"Cushing's Syndrome-Topic Overview." WebMD - Better Information. Better Health. Web. 28 Nov. 2011. <http://www.webmd.com/a-to-z-guides/cushings-syndrome-topic-overview?page=2>.

"CUSHINGS SYNDROME -- WHAT IT IS AND SYMPTOMS - Topic." Forums. Web. 28 Nov. 2011. <http://community.discovery.com/eve/forums/a/tpc/f/5241904768/

m/50919420001>.

Staff, Mayo Clinic. "Cushing's Syndrome: Causes - MayoClinic.com." Mayo Clinic. Web. 28 Nov. 2011. <http://www.mayoclinic.com/health/cushings-syndrome/DS00470/DSECTION=causes>.

230 lbs later...

Mystery Diagnosis #6

Charlotte was a healthy, attractive, active 31 year-old woman.  Charlotte had long blonde hair and was a size 2 all her life.  Suddenly, out of the blue Charlotte noticed she was beginning to put on weight.  In less than 3 weeks Charlotte gained about 15 lbs and doctors recommended that she keep exercising and dieting.  Charlotte is told that nothing is wrong; however, her body keeps expanding.  When Charlotte gains weight it was mostly in her stomach and upper abdomen.  She gained 100 lbs in only one year.  Charlotte also began to notice her hair was falling out, she had increased fatty tissue around her neck,  and her skin was frail and oily.  Charlotte also found herself not being able to sleep at night, feeling restless.  Charlotte continued to cut down her calories and upped her cardio; however, the weight gain still continued.  


Charlotte, desperate for answers saw a total of 15 highly recommended physicians and specialists.  Still, no one could find an answer.  Charlotte was even labeled a hypochondriac.  Seven years and 230 lbs later, Charlotte decided to take matters into her own hands.  She finally found her answer.

Clinical Manifestations 

Signs and Symptoms:

·         Extreme weight gain

·         Insomnia

·         Oily and frail skin

·         Hair loss

·         Increased fat around the neck 

What do you think?

Zzzzzzzz’s

Answer to Mystery Diagnosis #5:

  

Addison’s Disease

          Addison’s disease is a disorder that occurs when the adrenal glands do not produce an adequate amount of the hormone cortisol (and in some cases the hormone aldosterone).  Addison’s disease affects both men and women equally and people of all ages.  It is characterized by fatigue, weight loss, weakness and low blood pressure (hypotension).  Addison’s disease affects about 1 in 100,000 people. 

 

          The hormone cortisol has many vital tasks that helps the body; maintain blood pressure and heart function, respond to stress, slow the immune system’s inflammatory response, balance the effects of insulin, maintain proper arousal and sense of well-being, and regulates metabolism of proteins, carbohydrates, and fats. 

          The hormone aldosterone helps the body maintain blood pressure and water and salt balance.  When aldosterone levels are low, the kidneys are unable to regulate salt and water balance causing blood volume and blood pressure to drop. 

  

Signs and Symptoms:

·         Muscle weakness

·         Fatigue

·         Weight loss and decreased appetite

·         Darkening of your skin (hyperpigmentation)

·         Low blood pressure, even fainting

·         Salt craving

·         Low blood sugar (hypoglycemia)

·         Nausea, diarrhea or vomiting

·         Muscle or joint pains

·         Irritability

·         Depression

Treatment:

·         The treatment for Addison’s disease involves taking hormones to replace the insufficient amount being produce by the adrenal glands. 

o   For cortisol replacement – hydrocortisone tables

o   For aldosterone replacement –  Florinef (fludrocortisone acetate)

Addison’s disease affects about 1 in 100,000 people.  If left untreated it can cause an “Addisonian crisis” that can be fatal.  “Addisonian crisis” is when a constellation of symptoms cause a severe adrenal insufficiency.  

 JFK is one of the best-known Addison’s disease sufferers.  

Works Cited

"Addison's Disease Causes, Symptoms, Diagnosis, and Treatment on MedicineNet.com." Web. 14 Nov. 2011. <http://www.medicinenet.com/addison_disease/article.htm>.

Staff, Mayo Clinic. "Addison's Disease: Causes - MayoClinic.com." Mayo Clinic. Web. 14 Nov. 2011. <http://www.mayoclinic.com/health/addisons-disease/DS00361/DSECTION=causes>.

Zzzzzzzz’s

Mystery Diagnosis #5

  

Jake, a 13 year old boy went to his pediatrician with a chief complaint of fatigue.  Jake stated that he had been feeling extreme fatigue for a couple of months.  Jake also has been suffering from chronic diarrhea, loss of appetite, and unintentional weight loss.  Jake’s mother stated that he has been moving sluggish and wanted to rule out mono.  Upon physical exam Jake dark patchy skin on his knees and elbows.  Jake was also hypotensive (low blood pressure). 

Similar darkening of skin that Jake has.

Signs and Symptoms:

·         Fatigue

·         Muscle weakness

·         Lack of appetite

·         Unintentional weight loss

·         Diarrhea

·         Dark patchy skin

·         Hypotension

What do you think Jake has?

Hint: He does not have mono. 

Wait, huh?

Answer to Mystery Diagnosis #4:

Urinary Tract Infection

Urinary System 

A Urinary Tract Infection (UTI) is an infection that starts in your urinary system.  The urinary system is composed of the kidneys, ureters, bladder, and urethra.  Most UTIs involve the infection of the lower urinary tract – the bladder and the urethra.  A UTI is caused by a pathogenic organism (bacteria, fungi, or parasite).  The most common cause of UTI infections is the Escherichia coli bacterial strains that usually inhabit the colon.  Other bacteria that cause UTI infections include; Pseudomonas, Staphylococcus, Mycoplasma, Chlamydia, and Neisseria.  Fungi that can cause UTIs consist of Candida (yeast) and parasites such as Trichomonas. 

There are many risk factors of UTIs.  In general, any interruption or impedance of the normal flow of urine is a risk factor.  Women are more susceptible than men to UTIs because a woman’s urethra is shorter than a man’s.  Also, a woman’s urethra’s exit is close to the colon, which allows easier entry for pathogens.   

Signs and Symptoms (young individuals):

·        Frequent urge to urinate

·        Pain or burning during urination

·        Cloudy urine

·        Blood in urine can be present

·        Abdominal discomfort

·        Fever

Signs and Symptoms (in the elderly):

·        Mild or NO symptoms of UTI as seen in younger individuals)

·        Weakness

·        Lethargic

·        Sudden onset of confusion

·        Agitation

Detection of UTI:

·        Urine sample – a urinalysis will detect a high number of white blood cells (leukocytes), + bacteria, and + nitrite. 

Treatment of UTI

·        Antibiotics such as Ciproflaxacin (Cipro)

·        Home remedies include; cranberry juice, yogurt, and vitamin C.

Most UTIs cause no complications if they are treated quickly.  However, if left untreated UTIs can lead to dehydration, kidney failure, and sepsis. 

In Norma’s case, she displays the typical signs of an UTI that occurs in the elderly – a sudden onset of confusion and agitation. 

References:

Davis, Charles P., and Jerry R. Balentine. "Urinary Tract Infection (UTI In Adults) Symptoms, Causes, Treatment - What Causes a UTI on MedicineNet." MedicineNet.com. Web. 31 Oct. 2011. <http://www.medicinenet.com/urine_infection/page2.htm>.

Wait, huh?

Nora is a very active and lively 81 year-old grandmother.  Nora has been living in her daughter’s house for about the past five years and helps out with cooking, cleaning, laundry, and her grandchildren’s homework.  One day, Nora’s daughter noticed that Nora has been displaying a sudden onset of confusion and agitation.  Throughout the day, Nora’s mood changed dramatically and drastically.  So much, that Nora had no idea who her daughter or her grandchildren were.  Nora was also unable to perform her daily tasks that she was able to do the day before. 

Nora’s daughter took Nora immediately to her PCP (primary care physician) to figure out what was going on.  At the PCP, Nora did not complain of any pain or discomfort and she did not have a fever.  She was alert and oriented x 2 (she was oriented to time and place but not to person). 

Signs and Symptoms:

Sudden onset of –

1)    Confusion

2)    Agitation

What do you think Nora has?

Wisdom Teeth

Answer to Mystery Diagnosis #3:

Toxic Shock Syndrome

Toxic Shock Syndrome (TSS) is a toxin-mediated acute life-threatening illness that is caused by the bacterium Staphylococcus aureus or Streptococcus pyogenes.  

TSS was first discovered in 1978 and was originally liked to the use of tampons.  However, 50% of TSS cases are not associated with tampon use.  Other cases of TSS can include the bacterium invading areas of injured skin (such as cuts and scrapes), burns, and surgical sites.   

Signs and Symptoms:

·         High fever

·         Rash that resembles a sun burn

·         Desquamation (skin peeling)

·         Hypotension

·         Multi-organ failure (involving 3 or more organ systems)

·         Myalgia (muscle pain)

·         Vomiting

·         Diarrhea

·         Headache

To detect TSS:

·         Blood cultures may be positive for Staphylococcus aureus or Streptococcus pyogenes growth

·         Usually diagnosed based on signs and symptoms

Treatment

·         Antibiotics

·         Dialysis (if kidney problems occur)

·         Fluids intravenously

·         Blood pressure medications

·         Removal of foreign materials (such as tampons or nasal packing)

·         Site of infection will be drained

TSS is a rare; however, it can fatal in up to 50% of cases.  In order to prevent TSS; wash your hands often, use a clean bandage for skin wounds, avoid tampons or change tampons frequently.   

My cousin obtained TSS by the bacteria Streptococcus pyogenes.  Streptococcus pyogenes is the strain of bacteria that causes strep throat.  My cousin was not aware that she was sick with strep throat when she had her wisdom teeth removed.  During her surgery, the S.pyogenes bacteria traveled into her surgical sites in her mouth and then infected her blood stream.  And that is how she became infected with TSS. 

References:

Larissa, Hirsch. "Toxic Shock Syndrome." KidsHealth - the Web's Most Visited Site about Children's Health. Jan. 2011. Web.17 Oct. 2011.  <http://kidshealth.org/parent/infections/skin/toxic_shock.html>.

"Toxic Shock Syndrome - PubMed Health." PubMed Health. 11 Sept. 2010. Web.17 Oct. 2011.                 <http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001676/>.

Venkataraman, Ramesh, and Michael R. Pinsky. "Toxic Shock Syndrome." Medscape. 16 July 2010. Web. 17 Oct. 2011. <http://emedicine.medscape.com/article/169177- overview>.

Wisdom Teeth

My cousin was 18 years old when she had her wisdom teeth removed.  Her surgery went smoothly and there were no complications.  About four days after her surgery, she was feeling pretty sick.  She had a very high fever, muscle aches, headaches, hypotensive (low blood pressure), and a rash.  Her rash was widespread, red, and looked like a sunburn.  My cousin went into the emergency room and tests showed that her kidneys and liver were going into organ failure.   She was also experiencing signs of heart failure.   Her skin was peeling due to the rash and her hair was falling out.   She was immediately admitted into the hospital.  This was a very serious condition that she almost died from. 

Signs and Symptoms:

-malaise (a feeling of general discomfort)

-high fever

-muscle aches

-rash that resembled a sunburn

-hypotension (low blood pressure)

-kidney, liver, and heart failure

What do you think is going on?

Boy Scout

Answer to Mystery Diagnosis #2:

Rocky Mountain Spotted Fever

Rocky Mountain Spotted Fever is a disease that is caused by the bacteria, Rickettsia rickettsii, carried by ticks.  The bacterium is spread to humans by a tick bite.   

Most recent cases of Rocky Mountain Spotted Fever have been reported in Virginia, North Carolina, South Carolina, Maryland, Georgia, Tennessee, and Oklahoma. 

Most cases occur in the spring and summer months.  In 2006, approximately 2,300 cases were reported in the United States. 

Risk factors include hiking or camping in heavily wooded areas. 

Signs and Symptoms

-         Chills

-         Confusion

-         Fever

-         Headache

-         Muscle pain

-         Rash – rash usually first appears on wrists and ankles with spots that are 1 – 5 mm in diameter

Serious complications can occur such as; brain damage, heart failure, kidney failure, meningitis, pneumonitis, shock, and lung failure.  Paralysis, hearing loss, and nerve damage can also occur. 

Tests to detect RMSF:

-         Antibody titer

-         Complete blood count (CBC)

-         Kidney function tests

-         Partial thromboplastin time (PPT)

-         Prothrombin time (PT)

-         Urinalysis

-         Skin biopsy

If RMSF is left untreated it can become life-threatening and fatal.   About 3% of people who get this disease will die. 

Watch out for those tick bites! Make sure if you are out camping or hiking you take extra precautions because RMSF is known to occur in ticks located in Virginia.  Wear long pants, shirts, closed toed shoes, and tick repellent.  

“Rocky Mountain Spotted Fever – PubMed Health.”  Rocky Mountain Spotted Fever.  9 June 2011.  

 Oct. 2011. <http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH00001677/>