Nursing
In at least 375 words, or 1.5 double-spaced pages, prepare a case report that addresses the following:
Based on the case study provided, respond to the following questions:
Identify and differentiate the symptoms from the signs in this patient.
Is there any remarkable personal, social, and/or family history?
What results do you expect to find in the tests ordered?
What is the etiology of acromegaly? What is the prognosis?
How can you differentiate acromegaly from gigantism?
The patient refers to muscle weakness. Mention some common muscular diseases, and explain them briefly, including their prognoses.
Is Mr. Bryan at risk of suffering from diabetes mellitus? Why? How many types of diabetes mellitus are there? What are the differences between them?
Normally, the thyroid is not visible or palpable. What is the medical term for thyroid enlargement? Is thyroid enlargement always linked to a hyperthyroidism or a hypothyroidism? What is the functional relationship of the thyroid with the parathyroid?
Is it common to see Cushing’s disease associated with acromegaly? What is the difference between Cushing’s disease and Cushing’s syndrome? What is Addison’s disease?
All references must be cited using APA Style format.
!!!Personal Information!!!
Name: Mr. Elliot Bryan
Age: 29 years old
Gender: Male
Description
Mr. Bryan is a 29-year-old married man who came to the medical office because, over the last three years, he has progressively increased the size of his shoes, and he has resized his wedding ring three times. He says his feet and hands have grown. He has also noticed that his face has turned coarse. He was a very active man and practiced sports, but now he fatigues just by walking, and feels weakness in his muscles and stiffness in his joints. He is depressed because in the last few months he has been experiencing erectile dysfunction, which is affecting his relationship with his wife. He feels he is losing his vision as well.
Mr. Bryan does not drink alcohol, smoke, or use any recreational drug. His mother suffers from diabetes mellitus type II, and his father suffers from hypertension.
On physical examination we found:
Remarkable Signs on Physical Exam by Regions
Head: Enlarged and coarsened facial features, prominent superciliary arches, prognathism
Neck: Thyroid is visible and palpable
Thorax: Barrel appearance
Abdomen: Hepatomegaly. Splenomegaly.
SOMA: Enlargement of the hands and feet. Generalized arthralgia.
Remarkable Signs on Physical Exam by Systems
Integumentary system: Thick and oily skin. Numerous acrochorda disseminated throughout the body.
Cardiovascular system: Blood pressure 150/100. Radial pulse 72.
Digestive system: Megaloglossia. Diastema.
Lab Tests
Complete blood count (CBC)
GH measurement
IGF-I measurement
Growth hormone suppression test
Glucose level
Brain MRI
Abdominal CT scan
Echocardiogram
Diagnosis
Acromegaly
Supporting Material
Mr. Bryan is a young man afflicted with acromegaly, which affects a very small number of people. However, numerous disorders of the endocrine, musculoskeletal, and integumentary systems are very common, such as diabetes, arthritis, and acne. Having a good understanding of the systems in this module will help you improve the lives of patients suffering from these common disorders, as well as patients who suffer from the uncommon ones, like Mr. Bryan.
ANSWER
Case study of Mr. Bryan
The differentiation of symptoms and signs, in this case, relies on the assessment and physical examination of the patient. The symptoms are manifestations of the disease that are apparent to the patient while the signs entail the conditions that the physician perceives. The patient has shown symptoms such as increasing size of the legs and fingers, loss of vision, and erectile dysfunction. The signs that are experienced by the physician include thyroid is visible and palpable, Enlarged and coarsened facial features, prominent superciliary arches, prognathism, Barrel appearance, enlargement of the hands and feet. Generalized arthralgia, numerous acrochordon disseminated throughout the body, and Blood pressure 150/100 while Radial pulse 72.
The prevalence of any remarkable details in the patient’s family, social and personal history is essential in making an accurate diagnosis. The family history indicates that his father suffers from hypertension while his mother suffers from type 2 diabetes mellitus.
The complete blood count is a blood test that is used to examine the overall health as well as to detect a wide range of disorders such as infection, anemia, and leukemia. The GH measurement is used to measure the among of Growth hormone in the blood. IGF-I measurement is used to detect excessive growth hormone and amount of insulin-like growth factor-1. The growth hormone suppression test is used to examine whether the growth hormone production is being suppressed by the high blood sugar in the body. A glucose level test is used to examine the amount of glucose and sugar in the body. Brain MRI is a painless and sate test that offers detailed images of the brain stem and the brain and can detect tumors, cysts, bleeding problems among other problems. An abdominal CT scan helps in detecting images of the colon, small bowel, and other internal organs to examine unexplained pain. An echocardiogram test is used to identify the possible blood clots and fluid buildup in the heart’s valves and chambers.
The etiology of acromegaly is the disorder in adults in which the pituitary gland leads to the production of many growth hormones that result in enlargement of hands, feet, and face (Melmed, 2017). The tumor produces an excessive amount of growth hormone thus causing acromegaly. The outcomes of acromegaly depend on how severe the disease is and how the therapists low the symptoms since the excessive growth hormone can lead to tall stature and accelerated growth.
Gigantism is the abnormal high linear growth due to high insulin-like growth factor during childhood while acromegaly is a similar disorder with insulin-like growth factor but happens after the growth plate cartilage fuses during adulthood (Makri and Lodish, 2019). Gigantism is proportional and skeletally immature while acromegaly happens in skeletally mature people and only influences those bones that have continuous growth.
Myopathies are neuromuscular disorders whose main symptom is muscle weakness. These include polymyositis, muscular dystrophy, dermatomycosis, and myasthenia gravis (Shieh, 2013). Polymyositis is a disease that leads to muscle weakness of both sides of the body which makes it difficult to rise and lift objects. muscular dystrophy is an inherited disease that weakens and damages muscles over time due to a lack of protein essential for normal muscle function. Dermatomycosis affects the skins and muscles through degenerative changes of the muscles. There is no cure for dermatomycosis’s but symptom improvement occurs by increasing muscle strength.
Disorders of the integumentary systems, musculoskeletal and endocrine systems occur in diabetes mellitus due to reduced blood supply in the muscles. The abnormalities in these systems can be prevalent in patients with diabetes. Therefore, since diabetes mellitus can be inherited and the symptoms identified in Mr. Bryan, he is at risk of suffering from diabetes mellitus. There are two types of diabetes mellitus; Type 1 diabetes and Type 2 diabetes. Type 1 diabetes develops at any age but occurs more in children while type 2 diabetes is more common in adults due to resistance of insulin action.
The medical term for enlargement of the thyroid is a goiter. Enlargement of the thyroid is linked to elevated hyperthyroidism and decreased hypothyroidism. Thyroid and parathyroid act as messengers affecting tissues and cells in different parts of the body. Thyroids affect the body’s metabolic rates while parathyroid controls the number of important tissues such as calcium ion levels in the body.
Cushing diseases are associated with acromegaly since they are the most common pituitary diseases due to hormonal excessive growth (Nieman, 2018). The difference between Cushing’s syndrome and Cushing’s disease is that Cushing’s disease is a particular type of Cushing syndrome after the pituitary tumor makes the body produce much cortisol. The effects of the cortisol add up to the Cushing syndrome. Cushing syndrome can also be caused by the overuse of cortisol medication. Addison’s disease is a disorder whereby the adrenal glands fail to produce enough hormones. The adrenal glands produce insufficient aldosterone and hormone cortisol which may lead to threatening Addisonian crises that are defined by low blood pressure.
References
Melmed, S. (2017). Acromegaly. In The pituitary (pp. 423-466). Academic Press.
Makri, A., & Lodish, M. (2019). Gigantism and Acromegaly. In Pituitary Disorders of Childhood (pp. 121-139). Humana Press, Cham.
Nieman, L. K. (2018). Recent updates on the diagnosis and management of Cushing’s syndrome. Endocrinology and Metabolism, 33(2), 139-146.
Shieh, P. B. (2013). Muscular dystrophies and other genetic myopathies. Neurologic clinics, 31(4), 1009-1029.
