Mr. Smith is 60 years old. He was diagnosed with a prostatecancer five years ago. Over the past few days, Mr. Smith has beenfeeling weak and increasingly tired and has also been sufferingfrom a headache that did not respond to over-the-countermedications. He scheduled an appointment with his physician.
His physician performed a physical examination and recommended abattery of laboratory tests and imaging procedures.
The table below shows Reference values in the right-hand column.These values reflect the normal range of values for patientswithout disease or illness. The center column reflects theresulting values for medical test results obtained for Mr.Smith.
Take note whether Mr. Smith’s values are within normallimits.
| Mr. Smith | Reference Values |
K+ | 2.6 mmol/L | 3.8-4.9mmol/L |
Hb (Hemoglobin) | 7.5 g/dLÂ Â | 13.8 to 18.2 g/dL |
Hct (Hematocrit) | 20.4%Â Â Â Â Â Â | 45-52% |
Platelet Count | 49x109/L | 150-400x109/L |
After receiving Mr. Smith’s test results, his physician admitshim to the hospital. Hospital staff treated him and dischargedhim.
The following week, Mr. Smith returns to his physician with thesame complaint of weakness and a new complaint of shortness ofbreath. His blood pressure is 160/100 mmHg. MRI reveals metastasisof prostate cancer to osseous tissue. Abdominal CT showsobstruction of intestine due to nodular enlargement of adrenalglands.
Laboratory results from Mr. Smith’s second hospital admissionand medical tests show following findings:
| Mr. Smith | Reference Values |
K+ | 2.6 mmol/L | 3.8-4.9mmol/L |
Hb | 7.3 g/dl | 13.8 to 18.2 g/dL |
Hct | 20.4% | 45-52% |
Platelet Count | 20x109/L | 150-400x109/L |
HCO3 | 38 mmol/l | 22-26 mmol/L |
Urinary K+ | 70 mmol/L/24 hr | 25-120 mmol/L/24 hr |
Blood Glucose | 460 mg/dl | 64.8-104.4 mg/dL |
Serum Aldosterone | 1 ng/dl | |
24 hour Urinary Aldosterone | 8.4 mcg/24 hr | 2.3-21.0 mcg/24 hr |
Renin | 2.1 ng/ml/hr | 0.65-5.0 ng/ml/hr |
ACTH (Adrenocorticotropic Hormone) | 1082 pg/ml | 9-46 pg/ml |
Cortisol | 155.5 microg/dL | 0-25 microg/dL |
CONCLUSION AND DIAGNOSIS
Laboratory findings, MRI and CT confirmed metastatic prostateadenocarcinoma, hypertension and refractory hypokalemia due toectopic ACTH production. High levels of circulating cortisol causedcontinuous activation of mineralocorticoid receptors resulting inhypokalemia, metabolic alkalosis and hypertension.
After reading provided scenario, answer the followingquestions:
1.  What are the components of physical examination?Describe each component. (See Module 1, Commentary, Topic8. Disease Categories, Part B. Steps in Diagnosis)
2.  Mr. Smith’s blood pressure was 160/100 mmHg. Howdoes a medical provider take or measure blood pressure? What do thetop (numerator) and bottom (denominator) numbers mean in thebiological sense? What is the significance the size of these twonumbers? Is Mr. Smith’s blood pressure within normal range? Explainhow you concluded whether Mr. Smith’s blood pressure is/is notwithin normal range.
3.  Based on the data provided, what laboratory testswere performed and what samples were taken from the patient? Selectone of the laboratory tests ordered for Mr. Smith and discuss whyMr. Smith’s physician might have ordered the test and theinformation she might have expected to obtain from that particulartest.
4.  Compare Mr. Smith’s values with reference valuesand indicate whether MR. Smith’s values are below, above, or withinnormal range (compare Mr. Smith’s values with the Reference values)for each laboratory tests in the table above from the second set oftests.
5.  What imaging procedures did Mr. Smith undergo?Discuss the distinctions and similarities between the two differentimaging approaches. What were the results of imaging procedures inMr. Smith’s case?
6. Select one of the medical terms from the CONCLUSION andDIAGNOSIS section above and define what it means. Also, discuss, inyour own words and based on what you can gather about Mr. Smith’scondition, how the laboratory or imaging tests helped with drawinga conclusion or making the diagnosis. In your own words, discusshow medical providers use the scientific method to come to workthrough the examination and diagnosis of a patient.
