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NURS 711
PATHO GRAND ROUNDS CASE STUDY: ENDOCRINE AND REPRODUCTIVE
DISORDER
A 25-year old female presents with for a pregnancy test. She and her husband have been trying
to conceive for 6-months. She has been off oral contraceptives for 6 months. Her menstrual
cycles are regular and occur every 28-days. She reports she missed her last period that should
have started 1 week ago. She took a home pregnancy test that was negative. She also reports a
small amount of milk discharge from both breasts that started 2 weeks ago.
Past Medical History: G0, Normal Pelvic & Pap 3 months ago.
Surgeries: None
Medications/Supplements: Multivitamin Daily
Allergies: None
Vaccinations: Up-to-date
Family History: Mother diagnosed with Type I Diabetes at age 12-years old; Father has liver
cirrhosis from alcohol abuse.
Social History: Married for 1 year, lives with her husband, lifetime sexual partners: 1- her
husband. Denies tobacco, alcohol, or recreational drug use. Works full time as a medical office
assistant. Exercises regularly- walks 30 minutes 5 days/week.
Review of Systems: 12-point review of systems negative except bilateral galactorrhea as
detailed above.
Physical Exam: Vital Signs: 110/80 HR 75 RR 12 T 98.5F BMI 20. General: well developed
female, no acute distress. Skin: warm and dry without lesions; ivory skin tone, normal turgor, no
hirsutism noted. HEENT: Head- Normocephalic, atraumatic, PERRLA, tympanic membranes
without erythema bilaterally, nares without edema or drainage, oral cavity without lesions or
ulcerations, teeth appear of good hygiene and without caries. Neck: supple without thyromegaly
or lymphadenopathy. Cardiac: S1S2 regular rate and rhythm without murmurs, clicks, rubs.
Chest: Non-labored respiratory effort; symmetrical expansion; lung sounds clear to auscultation
anteriorly and posteriorly throughout. Breast/axilla: no dimpling, erythema, symmetrical; no
masses, tenderness, discoloration; nipples with small amount of galactorrhea bilaterally without
manual expression; no axillary lymphadenopathy. Abdomen: flat, soft, with active bowel sounds,
nontender, no bruits, masses, or organomegaly. Musculoskeletal: Active ROM of all extremities,
strength 5/5 of upper and lower extremities bilaterally; DTRs 2+. Neuro: A/Ox 3, CN II-XII
intact, normal gait, no deficits.
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NURS 711
Chemistry
Thyroid Function
Na
140 meq/L
TSH
4.5 mU/mL
K+
4.0 meq/L
T3
150 ng/dL
Ca
8.5 mg/dL
T4, Free
15.3 pmol/L
Cl
103 meq/L
Beta-HCG- Undetectable
HCO3
25 meq/L
Serum Prolactin Series
BUN
10 mg/dL
Sample 1
64ng/mL
Cr
0.7 mg/dL
Sample 2
68 ng/mL
Glucose
90 mg/dL
Sample 3
65 ng/mL
AST
25 IU/L
ALT
40 IU/L
WBC
5,000/mm3
Alk Phos
65 IU/L
HgB
15
Bili, Total
0.8 mg/dL
Platelets
350/mm3
Blood Counts
MRI of the pituitary and hypothalamus was negative for lesions.
Review Questions:
1.
2.
3.
4.
What are 4 high level differential diagnosis for this patient?
Does this patient have any risk factors for hyperprolactinemia?
What clinical manifestations are consistent with hyperprolactinemia?
What is the significance of the physical examination finding a normocephalic atraumatic
skull?
5. What is the significance of the BUN and Cr results?
6. What is the significance of the AST, ALT, and total bilirubin results?
7. What is the significance of the TSH, T3, T4 results?
8. Which of the thyroid function test would abnormally elevated inf the patient had primary
hypothyroidism?
9. What is the significance of the of the beta-HCG test?
10. What is the significance of the serum prolactin levels?
11. What is the significance of the pituitary MRI and hypothalamus?
12. What is the significance of the normal CXR?
13. What is the diagnosis for this patient?
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NURS 711
14. What is the appropriate therapy for this patient?
15. Discuss a therapeutic approach to caring for this patient from a Biblical worldview.
References
McCance, K.L., & Heuther, S.E. (2019). Pathophysiology: The biologic basic for disease in
adults and children (8th ed.). Mosby.
Pagana, K.D., & Pagana, T.J. Mosby’s Diagnostic & Laboratory Test Reference (Current ed.).
Mosby.
Page 3 of 3
Nursing Question
Learning Goal: I’m working on a nursing case study and need an explanation and answer to
help me learn.
TOPIC
Patho Grand Rounds Case Study:
Endocrine and Reproductive Disorders
Assignment.
Type 1 Diabetes
Requirements: 5 pages
PATHO GRAND ROUNDS CASE STUDY ASSIGNMENT INSTRUCTIONS
OVERVIEW
This assignment provides the opportunity for students to research, analyze, and discuss an
assigned case study. You will develop understanding of physiology and pathophysiology to
make clinical decisions, manage disease, and conditions at the advanced practice nurse level.
INSTRUCTIONS
1. Read Patho Grand Rounds Case Studies.
2. Review the Patho Grand Rounds Case Study questions and be prepared to discuss your
answers during the Patho Grand Rounds meeting.
3. Participation. Each student will be evaluated on the following participation expectations:
• Be prepared to discuss the Patho Grand Rounds Case Study in a robust manner;
make substantial contributions to the overall discussion.
o Demonstrate thoughtful analysis of points presented.
o Encourage and facilitate interaction aimed at increasing understanding of the
disorder presented and developing diagnostic reasoning.
o Provide examples to support points discussed.
o Offer additional questions for thoughtful consideration.
Note: Your assignment will be checked for originality via the Turnitin plagiarism tool
NOTE:
Please see the case study and we need to answer a bunch of questions which you will see
at the end.

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