Гормональная регуляция обмена веществ и анализ клинических случаев

8.2.3 Actions of hormones that regulate fuel metabolism Homework Problems Problem 8.2.3.1 As a third-year medical student, you examine your first patient. You find that he is 52 years old, has a round face, acne, and a large hump of fat on the back of his neck. He complains that he is too weak to “mow his lawn.” His fasting blood glucose level is 170 mg/dL (reference range, 80 to 100 mg/dL). His plasma cortisol levels are 62 μg/mL (reference range, 3 to 31μg/mL). His plasma ACTH levels are 0 pg/mL (reference range, 0 to 100 pg/mL). Based on the information given, if the patient’s problem is attributable to a single cause, the most likely diagnosis is which of the following? Explain your answer. A. Non–insulin-dependent diabetes mellitus B. Insulin-dependent diabetes mellitus C. A secretory tumor of the anterior pituitary D. A secretory tumor of the posterior pituitary E. A secretory tumor of the adrenal cortex Problem 8.2.3.2 A woman was scheduled for a growth hormone suppression test. If each of the following events occurred the morning of the test, which one of the events would be most likely to cause a decrease in growth hormone levels? Explain your answer. A. She ate four large doughnuts for breakfast. B. She was on estrogen replacement therapy and took her tablets after breakfast. C. While unlocking her car, she was chased by the neighbor’s vicious dog. D. She fell asleep at the start of the test and slept soundly until it was completed 1.5 hours later. E. She forgot to eat breakfast before the test. Problem 8.2.3.3 A dietary deficiency of iodine will lead to which of the following? Explain your answer. A. A direct effect on the synthesis of thyroglobulin on ribosomes B. An increased secretion of TSH C. Decreased production of TRH D. Increased heat production E. Weight loss Problem 8.2.3.4 A woman whose thyroid gland was surgically removed was treated with 0.10 mg of thyroxine daily (tablet form). After 3 months of treatment, serial serum TSH levels ranged between 10 and 15 mIU/mL (reference range, 0.3 to 5.0 mIU/mL). She complained of fatigue, weight gain, and hoarseness. Her dose of thyroid hormone should be adjusted in which direction? A. More thyroid hormone should be given B. Less thyroid hormone should be given C. No adjustment is needed Problem 8.2.3.5 A patient complains of nervousness, palpitations, sweating, and weight loss without loss of appetite, and has a goiter. Suspecting a defect in thyroid function, the physician orders a total serum T4. The test is performed by radioimmunoassay. The standard curve for the assay, which measures T4 in 0.1 mL serum, is shown in Figure 43.13. Normal levels of T4 4 to 10 μg/dL. In an assay of 0.1 mL of the patient’s serum, 15% of the radioactive T4 was bound by the antibody. According to the radioimmunoassay, the approximate blood level of T4 is which of the following? A. 0.015 μg/dL B. 0.15 μg/dL C. 15 μg/dL D. 20 μg/dL E. 30 μg/dL