1. Introduction
The Week 10 Case Study Assignment in NURS 6501 Advanced Pathophysiology often centers on endocrine disorders such as diabetes mellitus, thyroid disease, or adrenal dysfunction.

Students are expected to:

Analyze patient presentations.

Apply knowledge of pathophysiology.

Develop differential diagnoses.

Recommend evidence‑based treatment strategies.

This case study integrates clinical reasoning, advanced physiology, and pharmacologic principles.

2. Endocrine System Overview
The endocrine system regulates metabolism, growth, reproduction, and stress responses.

Major glands: pituitary, thyroid, parathyroid, adrenal, pancreas, gonads.

Disorders often involve hormone excess, deficiency, or resistance.

Common conditions:

Diabetes Mellitus (Type 1 & 2)

Thyroid Disorders (Hypothyroidism, Hyperthyroidism)

Adrenal Disorders (Cushing’s, Addison’s)

3. Case Study Focus: Diabetes Mellitus
Pathophysiology:

Type 1 DM: Autoimmune destruction of pancreatic beta cells → absolute insulin deficiency.

Type 2 DM: Insulin resistance + relative insulin deficiency.

Leads to hyperglycemia, microvascular (retinopathy, nephropathy, neuropathy) and macrovascular (atherosclerosis, stroke) complications.

Clinical Presentation:

Polyuria, polydipsia, polyphagia.

Fatigue, blurred vision, recurrent infections.

Poor wound healing.

Diagnostic Criteria (ADA):

Fasting plasma glucose ≥126 mg/dL.

HbA1c ≥6.5%.

Random glucose ≥200 mg/dL with symptoms.

4. Case Study Focus: Thyroid Disorders
Hypothyroidism:

Pathophysiology: Deficiency of thyroid hormone (T4, T3).

Causes: Hashimoto’s thyroiditis, iodine deficiency, post‑surgical.

Symptoms: Fatigue, weight gain, cold intolerance, constipation, dry skin.

Labs: Elevated TSH, low free T4.

Hyperthyroidism:

Pathophysiology: Excess thyroid hormone.

Causes: Graves’ disease, toxic multinodular goiter.

Symptoms: Weight loss, heat intolerance, palpitations, tremor, anxiety.

Labs: Low TSH, elevated free T4/T3.

5. Case Study Focus: Adrenal Disorders
Cushing’s Syndrome:

Pathophysiology: Excess cortisol (exogenous steroids or adrenal tumor).

Symptoms: Moon face, buffalo hump, central obesity, striae, hypertension, glucose intolerance.

Addison’s Disease:

Pathophysiology: Adrenal insufficiency → low cortisol and aldosterone.

Symptoms: Fatigue, weight loss, hyperpigmentation, hypotension, hyponatremia, hyperkalemia.

6. Differential Diagnosis Process
Step 1: Identify key symptoms (fatigue, weight changes, polyuria).

Step 2: Match with possible endocrine disorders.

Step 3: Order labs (glucose, HbA1c, TSH, cortisol).

Step 4: Rule out mimicking conditions (depression, anemia, renal disease).

Step 5: Confirm diagnosis with imaging or specialized tests if needed.

7. Treatment Strategies
Diabetes Mellitus:

Lifestyle: diet, exercise, weight management.

Pharmacology:

Type 1: Insulin therapy.

Type 2: Metformin, GLP‑1 agonists, SGLT2 inhibitors, insulin if needed.

Monitoring: HbA1c every 3–6 months.

Hypothyroidism:

Levothyroxine replacement.

Monitor TSH every 6–8 weeks initially.

Hyperthyroidism:

Antithyroid drugs (methimazole, PTU).

Radioactive iodine therapy.

Beta blockers for symptom control.

Cushing’s Syndrome:

Surgical removal of tumor.

Gradual steroid taper if exogenous cause.

Addison’s Disease:

Glucocorticoid replacement (hydrocortisone).

Mineralocorticoid replacement (fludrocortisone).

8. Role of the Advanced Practice Nurse
Perform comprehensive assessments.

Interpret labs and imaging.

Develop differential diagnoses.

Initiate evidence‑based treatment.

Educate patients on lifestyle and medication adherence.

Monitor for complications and adjust therapy.

9. Case Example (Hypothetical)
Patient: 45‑year‑old female with fatigue, weight gain, cold intolerance.

Labs: TSH = 8.5 mIU/L (high), Free T4 = 0.6 ng/dL (low).

Diagnosis: Primary hypothyroidism.

Treatment: Levothyroxine 75 mcg daily, recheck labs in 6 weeks.

Outcome: Improved energy, weight stabilization, normalized TSH.

10. Summary
The Week 10 Case Study Assignment emphasizes clinical reasoning in endocrine disorders.

Key skills: understanding pathophysiology, applying diagnostic criteria, and tailoring treatment.

Advanced practice nurses play a vital role in bridging theory and patient care.

Mastery of these concepts prepares students for safe, effective, evidence‑based practice.

📝 Quiz (15 Questions)
Multiple Choice – Select the best answer.

Which hormone is deficient in Type 1 Diabetes Mellitus? a) Cortisol b) Insulin c) Thyroxine d) Aldosterone

Which symptom is NOT typical of hyperthyroidism? a) Weight loss b) Heat intolerance c) Constipation d) Palpitations

Elevated TSH with low free T4 indicates: a) Hyperthyroidism b) Hypothyroidism c) Addison’s disease d) Cushing’s syndrome

Which lab confirms diabetes mellitus? a) HbA1c ≥6.5% b) TSH ≥5.0 mIU/L c) Cortisol 2.0 ng/dL

Which symptom is common in Addison’s disease? a) Hypertension b) Hyperpigmentation c) Weight gain d) Moon face

Which drug is first‑line for Type 2 Diabetes? a) Insulin b) Metformin c) Levothyroxine d) Methimazole

Which treatment is used for hypothyroidism? a) Levothyroxine b) Insulin c) Hydrocortisone d) Radioactive iodine

Which therapy is definitive for Graves’ disease? a) Beta blockers b) Radioactive iodine c) Levothyroxine d) Hydrocortisone

Which condition is associated with “moon face” and “buffalo hump”? a) Addison’s disease b) Cushing’s syndrome c) Hypothyroidism d) Type 1 Diabetes

Which hormone is deficient in Addison’s disease? a) Cortisol b) Insulin c) Thyroxine d) Growth hormone

Which symptom is part of the “classic triad” of diabetes? a) Polyuria b) Constipation c) Hyperpigmentation d) Tremor

Which lab is monitored after starting levothyroxine? a) HbA1c b) TSH c) Cortisol d) Glucose

Which drug is used to control symptoms of hyperthyroidism? a) Beta blockers b) Insulin c) Levothyroxine d) Fludrocortisone

Which lifestyle change benefits Type 2 Diabetes? a) Increased sugar intake b) Regular exercise c) Sleep deprivation d) Smoking

Why is the nurse’s role critical in endocrine case studies? a) They prescribe only medications b) They integrate pathophysiology, diagnosis, and patient education c) They replace endocrinologists d) They focus only on lab results

Answer Key: 1‑b, 2‑c, 3‑