Endocrinology Case 1 2024

Patient presentation

Chief Complaint
"I've noticed that over the past six months, I have numbness in my hands and I am always tired"

HPI
GW is a 35-year-old man who presents to the clinic complaining of peripheral numbness and
tiredness. He indicated that he is taking his diabetes medication as prescribed by his doctor but
he missed a couple of follow-up appointments.

PMH
Type 1 diabetes mellitus x 20 years
Hyperthyroidism x 5 years before undergoing thyroidectomy 6 months ago.

FH
Mother, 62 years old, has hypertension; father, 64 years old, has hyperthyroidism; sister, 24
years old, has both hypertension and type 1 diabetes mellitus.

SH
Denies use of alcohol, tobacco, or illicit drugs; married with two children.

Meds
Lantus 25 units subcutaneously QHS
NovoLog 1:15 scale carb counting ratio subcutaneously with meals.

All
NKDA

1
ROS
Numbness in both hands and tiredness over 6 months associated with weight gain.

Physical Examination

GEN
Alert

VS
BP 125/75, HR 58, RR 14, T 37.2°C, Wt 80 kg, Ht 5'8″

SKIN
cold, dry, and intact.

HEENT
Normocephalic; oral mucosa moist. Pupils equal, round, and reactive to light. EOMI.

NECK
Well healed horizontal scar in front of the neck.

LUNGS
Lungs are clear to auscultation. Respirations are nonlabored.

CV
ECG shows prolonged QT interval.

ABD
Soft, nontender, and nondistended. Normal bowel sounds.

MS/EXT
No CCE; normal ROM.

NEURO
Alert.

PSYCH
Depressed, but cooperative.

2
Labs (Fasting, Drawn at 10:15 AM)

Na 130 mEq/L Hgb 12.8 g/dL AST 111 IU/L T. chol 168 mg/dL

K 4.9 mEq/L Hct 40% ALT 59 IU/L Trig 120 mg/dL

Cl 99 mEq/L RBC 4.88 x 106/mm3 Alk phos 75 IU/L Fe 93 mcg/dL

C02 26 mEq/L TSH 25.8 mIU/L

BUN 14 mg/dL Plt 244 x 103/mm3 GGT 63 IU/L Free T4 0.41 ng/dL

SCr 0.9 mg/dL WBC 3.6 x 103/mm3 LDH 173 IU/L

Glu 140 mg/dL Neutros 41% T. bili 1.1 mg/dL -HCG Qual neg

Ca (total) 4 mg/dL Lymphos 35% D. bili 0.5 mg/dL

Phos 8 mg/dL Monos 6% T. prot 7.3 g/dL A1C 8.2%

Uric acid 4.1 mg/dL Eos 2% Alb 4.1 g/dL

Basos 1%

UA
Clear, pale yellow, SG 1.020, pH 6.8, Ca 50 mg (range: 100–250 mg)

3
Questions

Student (1)

1.a. Create a list of the patient's drug therapy problems.

1.b. What information indicates the presence or severity of the patient’s conditions?

1.c What additional information/ laboratory tests can be used to aid in the diagnosis of the
patient’s condition?

Student (2)

2.a. What are the goals of pharmacotherapy in this case?

2.b. What feasible pharmacotherapeutic alternatives are available for the treatment of the
patient’s conditions?

Student (3)

3.a. What non-drug therapies might be useful for this patient?

3.b. What drug, dosage form, dose, schedule, and duration of therapy are best for this
patient?

Student (4)
4.a. What information should be provided to the patient to enhance adherence, ensure successful
therapy, and minimize adverse effects?

4.b. Explain how to monitor and evaluate the care plan for medication appropriateness,
effectiveness, safety, and patient adherence.