Talia Got the Kids Out of the Car and Went Inside the House - Management Assignment Help

Assignment Task:

Task:

Part I - It’s just a bit of weight gain and I’m tired, that’s all!
“It will put my mind at ease if you would make an appointment to see your doctor, I am concerned about your health,” said Talia as she parked the car in the driveway.
“It’s nothing, I’ve only gained a few kilograms around my waist and I am just tired because I am supervising the kids' remote learning while working and keeping the house clean”, replied Lynette. “I’ll go for a walk tomorrow and start watching what I am eating. I’ll be fine”, said Lynette.
“It’s not just that” continued Talia “I didn’t want to say anything, but I’ve noticed recently that you have started growing facial hair. I am worried about you, particularly given you have not menstruated in 6 months”
Talia got the kids out of the car and went inside the house. Lynette felt that Talia was over-reacting, afterall, they were busier than they had ever been and surely the constant stress of being in lockdown was the reason her period had stopped - she had heard stress could have a physical impact on your body.
Lynette grabbed the grocery bags from the car and as she entered the house, one of the heavier bags hit her leg. Lynette was surprised to see that her skin had torn and that she was bleeding. Afterall, it wasn’t a very hard knock at all. Perhaps Talia was right - it was time to make an appointment to see the doctor.

Part II - Dr Memon’s office
In Dr Memon’s office, Lynette explained the concerns that Talia had raised . When outlining what she was experiencing, Lynette realised many of her symptoms had been present for about 2 years. She had initially assumed it was due to being a busy mum of 2 young kids, resulting in a lack of sleep, stress and her not looking after herself. Lynette admitted to Dr Memon, that although she had been attempting to regulate her food intake and get more sleep in the last couple of months, there just did not seem to be any improvement in her fatigue or body weight. If anything, her symptoms were getting worse, something she had not wanted to admit to herself.
Dr Memon looked concerned. “Lynette, based on the symptoms that you have described, in combination with your previously diagnosed hypertension, I am concerned that you may have a hormone imbalance. A lot of the symptoms you are describing suggest an endocrine disorder such as polycystic ovarian syndrome, but I’d like to send you for some blood and urine tests to confirm, as well as referring you to see an endocrinologist,” said Dr Memon. “After all, we don’t want to treat the wrong disease - the symptoms you are describing can be present in many different hormonal imbalances”.

Part III - The Endocrinologist’s office
Lynette entered the waiting room of Dr Cheung’s office and it wasn’t long before the endocrinologist called her name.
“Lynette, looking at your test results, I can see that your fasting blood glucose is high and that you have an elevated level of the hormone cortisol in your blood and urine. It looks like your body is making too much of this hormone, indicating you may be suffering from some form of Cushing’s syndrome. Given that you are not on any steroid medications, which can affect blood cortisol levels, it is likely the source of the issue is internal. Therefore, I’d like you to repeat the urine sample, perform a couple of additional biochemical tests and organise for you to have an MRI of your brain to determine why this is the case. Once we have the results of these tests and scan, I will be able to more accurately diagnose your condition and develop a treatment plan” said Dr Cheung.
Lynette was concerned. “Why do you need to scan my brain?” she asked.
Dr Cheung explained that the release of cortisol in the body involved organs in both the abdomen and the brain and that an MRI may clarify where the imbalance was originating from. Ultimately, all of this information would allow Dr Cheung to provide an accurate diagnosis and effective treatment strategy.

Part IV - The diagnosis
Lynette underwent the biochemical tests and MRI at the local hospital and returned to Dr Cheung’s office.
“Good afternoon Lynette, please come in, I have your test results (Table 1) here and I would like to run through them with you,” said Dr Cheung.
Lynette sat and listened as Dr Cheung explained that the MRI had revealed a small (6 mm) microadenoma on her pituitary gland and that this was the reason her cortisol levels were elevated. He further explained that the biochemical tests revealed that her hormone levels were higher than normal at both morning and night. Furthermore, when biochemically challenged with dexamethasone, a synthetic corticosteroid, the level of cortisol, although still elevated, decreased significantly. The decrease in cortisol with the dexamethasone challenge was significant and confirmed Dr Cheung’s suspicion - Lynette had Cushing’s disease.

Table 1: Blood and urine test results, normal ranges and units.
Test Lynette’s Result Normal range Units
Morning plasma cortisol (8am) 1800 170 - 700 nmol/L
Evening plasma cortisol (11pm) 380 <50 nmol/L
Morning plasma ACTH (8am) 110 10-50 pg/mL
Evening plasma ACTH (11pm) 63 5-10 pg/mL
Morning plasma cortisol (8am) after 1mg dexamethasone test 780 <50 nmol/L
Cortisol (in urine) 17 <10 mg/24h
Fasting plasma glucose 7.2 4 - 5.5 mmol/L
Glucose (in urine) 8 Nil mmol/L

Lynette was shocked and took a few moments to let the diagnosis sink in. Dr Cheung reassured her that they could surgically remove the microadenoma from her pituitary and provide medication to treat her condition. Lynette left Dr Cheung’s office hopeful - there was a treatment for her condition and there was every chance that she would be able to lose the weight she had gained previously to feel more energised.

Read the case provided (“Is it just stress, or something else?”) before attempting to answer the following questions. When completing this section, use the rubric provided to assist you in constructing appropriate answers.
TOTAL WORD COUNT (1250 words, excluding references)
We have created a template to assist you in completing this assignment. Please answer the questions below using the template which you can find by clicking this link here.
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Question 1 (approximately 400 words)
Briefly describe what Cushing’s disease is. In your answer, be sure to include a brief explanation of:
· the difference between Cushing’s syndrome and Cushing’s disease
· the cause of Cushing’s disease
· how cortisol exerts its action on individual cells in the body, the physiological effect of cortisol and the associated physical symptoms when cortisol is in excess
· why Lynette’s plasma cortisol levels were tested both early in the morning and late in the evening.

Question 2 (approximately 250 words)
The synthesis and release of cortisol is under the control of the hypothalamic-pituitary-adrenal (HPA) axis.
A. Using text and an original diagram (created by you), describe the hormonal pathway that leads to the release of cortisol in a healthy individual.
In your response, you must include both written text and an original diagram (created by you) - these diagrams can be hand-drawn (and inserted as a photo from your phone) or created on the computer. Your diagrams should be clearly labelled, demonstrating your understanding of the details. Words included in the diagram do not contribute to your overall word count but should be succinct.
B. In the case of Cushing’s disease, discuss where in the above pathway the disruptions occur and how this alters the synthesis and secretion of hormones in the HPA axis. Add labels to your diagram in question 2a to demonstrate your understanding.
C. To diagnose Cushing’s disease, Lynette was given a synthetic drug called dexamethasone and her hormone levels were monitored. How does dexamethasone affect hormone synthesis and secretion in the HPA axis? Add labels to your diagram in question 2a to demonstrate your understanding.


Question 3 (approximately 300 words)
A comorbidity of Cushing’s disease is insulin resistance, leading to glucose intolerance and the development of type II diabetes mellitus. Using your knowledge gained from this unit in combination with some research:
A. Explain why continued excess cortisol secretion leads to Lynette’s symptoms of muscle weakness, central weight gain and hyperglycemia.
B. How do these factors eventually cause insulin resistance and type II diabetes mellitus?
Hint: For each of the three factors, think about what important metabolite (intermediate product of metabolism) is being used or broken down for use in the body’s various metabolic reactions. Then consider how these can lead to insulin resistance and type II diabetes mellitus.
Question 4 (approximately 300 words)
When in excess, cortisol can have an effect similar to that of the mineralocorticoid aldosterone on the renal tubules of the kidneys. Focusing on the effect at the kidney, explain how cortisol will have contributed to Lynette’s hypertension. How does the kidney normally respond to changes in systemic blood pressure? In your answer, be sure to include:
· the mineralocorticoid effect of cortisol at the kidney and the subsequent effect on systemic blood pressure
· how systemic blood pressure affects glomerular filtration rate (GFR)
· the intrinsic and extrinsic regulatory mechanisms for GFR
Hint, although not required, you may find it helpful to include a diagram or flow chart to summarise information and save on word count.

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