Discuss the magnitude of homone Response.?
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CASE STUDY 1
PERIOD (SECTION) _____________________
Jamie Richards is a 20 year old junior in college. She is majoring in biology and hopes someday to be a
pediatrician. Beginning about a month ago, Jamie noticed that she was waking up once, sometimes
twice a night, by the need to go to the bathroom. More recently, she has noticed that she needs to go to
the bathroom during her school day much more frequently than before, sometimes as often as once
At first, Jamie thought that her increased frequency of urination was due to all the coffee she drank, but
when she reduced her coffee consumption to one cup in the morning, she still needed to go to the
bathroom just as often. In addition, Jamie was buying bottled water by the case, and she found herself
never without a beverage in her hand or nearby. She also noticed that her urine seemed pale and
When Jamie told her mother or her problem, her mother became very concerned and arranged for
Jamie to see the family physician. Her physician found no abnormalities on physical examination.
However, a blood chemistry profile revealed the following
Plasma sodium level 149 mEq/kg
Plasma osmolality 308 mOsm/kg
Fasting plasma glucose 85 mg/dl
Urine osmolality 200 mOsm/kg
Urine glucose: negative
1. What are the normals for the above? What does osmolality mean? How is it measured?
Plasma sodium level
Fasting plasma glucose
Urine glucose level
An extensive history revealed that no other member of the family had ever displayed Jamie?s symptoms.
Jamie had no history of traumatic head injury and an MRI of her brain was normal. Because of the
increased diuresis diabetes was suspected.
2. Compare and contrast diabetes mellitus and diabetes insipidus. How does the mechanism by
which diuresis occurs with diabetes mellitus differ from that which occurs in diabetes insipidus
(specifically what causes the diuresis in each case)?
3. Discuss the two types of Diabetes mellitus (ie Type I and Type II). What is insulin? Where is it
produced? What is its chemical structure? How is its release regulated? Describe the
mechanism by which insulin normally regulates blood sugar in the body.
4. Discuss the two causes of Diabetes insipidus (ie neurogenic and nephrogenic). What is ADH?
Where is it produced? What is its chemical structure? How is its release regulated? Why is ADH
also known as Arginine Vasopressin? Describe the mechanism by which ADH normally regulates
urine volume and water conservation by the body.
5. Discuss the magnitude of hormone response. Include the 3 factors: 1) hormone level, 2)
receptor number and 3) hormone-receptor affinity. How can each of the above factors result in
a modified response of target tissues to the hormone?
Next, a glucose tolerance test was performed. On the day of the exam Jamie was told to refrain from
eating for 8 hours. Water was allowed but no other beverages. Jamie was scheduled for a 3 hour test.
Her weight was recorded at 122 lbs.
She was given a solution of concentrated glucose to drink. It contained 100 gram of glucose. Blood
samples were taken at the beginning of the test and hourly thereafter for 3 hours. The results were as
Initial blood glucose level: 80 mg/dL
1 hour: 160 mg/dL
2 hour: 120 mg/dL
3 hour: 95 mg/dL
A blood sample was also checked for A1C. The value was 5.4.
6. Discuss the above results. What levels would indicate diabetes mellitus? What is A1C? How is
it indicative of diabetes mellitus? Should multiple tests be performed? Do you think Jamie has
the disease? Why or why not?
Next, her doctor conducted a carefully monitored water deprivation test. The morning of the test Jamie
was weighed at the doctor?s office.
Her weight was recorded as 122 lbs.
Jamie was to remain at the doctors office for the duration of the test. She was put on fluid restriction.
A urine and plasma osmolality chart was started.
Hourly, the weight of the patient, and her urine and plasma osmolality were measured, and recorded on
Nurses were instructed to terminate fluid restriction if:
Patient?s weight fell by > 5%
Plasma osmolality increased to > 300 mOsm/kg.
If urine osmolality increased by <30 mOsm/kg (in total) over three successive urine samples
patient would proceed to DDAVP test
DDAVP test should be terminated if urine osmolality rose to >750 mOsm/kg
Jamie?s results were as follows:
8:00 122 lbs
9:00 121.5 lbs
Post DDAVP osmolality
10:00 120 lbs
nephrogenic diabetes insipidus
cranial diabetes insipidus
partial nephrogenic DI or primary polydipsia
partial cranial DI
7. What is DDAVP? What is the effect on the kidney? Discuss the monitoring of Jamie?s body
weight. Why was it important that her weight not be allowed to fall more than 5%? What acute
symptoms might she experience if it had?
7. Based upon the results above, and Jamie?s medical history, and the results of the MRI: Does
Jamie have Diabetes insipidus? If so?which type?
8. Write a short synopsis of the tests, the results, your diagnosis. What are your
recommendations to Jamie? Develop a treatment plan?
This question was answered on: Sep 18, 2020
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