Question: TH Patient 6-Polly Feels Poorly Polly Is A Student At UCA Who Has Always Been Outgoing And Extremely Active. For Quite Some Time, However, She Has Not Seemed Herself To Those Around Her. She Has Been Getting Sick Fre- Quently, And Always Seems To Feel Tired And Weak. Her Roommate Has Been Trying To Get Her To See You, Her Family Physician, But Polly …

TH Patient 6-Polly Feels Poorly Polly is a student at UCA who has always been outgoing and extremely active. For quite some time, however, she has not seemed herself to those around her. She has been getting sick fre- quently, and always seems to feel tired and weak. Her roommate has been trying to get her to see you, her family physician, but Polly has insisted she was fine. She figured her symptoms are simply due to the stress of school and lack of sleep from studying. As she was headed into the end of the semester and finals week, she was walking to class and felt a sharp pain in her left foot. She called her roommate to come pick her up and they head to your office. General Exam Diagnostic x-rays revealed fractures in metatarsals II and III. Polly tells you that she had a bone mineral density (BMD) test the previous year in one of her pre-nursing classes, which indicated osteopenia (pre-osteoporosis). She will be fitted for a boot which she will wear until the fractures heal. Polly then describes that she has not felt well for a long time. She describes her frequent colds, and explains that she always feels tired and weak. She reports a considerable weight gain, ex- cessive thirst (polydipsia) and urination (polyuria). You note increased tissue around Polly’s abdomen, between her should blades, and that she has a very round face. Initial Testing You order initial tests and receive the following results: Blood Glucose 145.8 mg/dl (normal 100 mg/dL) Total cholesterol: value is above normal limits Triglycerides: walue is above normal limits ACTH: value is below normal limits Free cortisol: value is above normal limits Hormone Polly Diagnosis Cushing’s Disease Cortisol List all evidence supporting your diagnosis. • Stress / lack of seep- feeling lived and weaky Frequent colds a considerable weight gain Increased tissue around Polly’s abdomen, between shoulder blades, a has a ‘veay round tuce + 1. Explain why her ACTH level is undetectable and cortisol level is above normal. • Cortisol is above normal showing a stress response because of school, her lack of sleep, and osteopenia in her left foot. •ACTH level is undetectable because… . 2. Why is her blood glucose elevated?