Solve the Medical Riddle: Her Broken Bone Isn’t Healing, Second Week

By Marie Savard MD

Editor’s note: Welcome to our ThirdAge feature that gives you a chance to play medical sleuth as we share the details of what happened when a patient presented with a problem that stumped the physician at first.

Last week, the patient reported her symptoms. The doctor proceeded with the examination using the components of the classic S-O-A-P notes, which are as follows:

S=Symptoms or Chief Complaint

O=Objective Findings

A=Assessment or Analysis

P=Treatment Plan or Recommendations

Kathy’s bone density test showed bone loss, a condition that is called osteoporosis. Her blood work showed abnormally high potassium level, low sodium level, and high blood urea nitrogen (BUN). Her bilirubin was normal so the darkened skin was not due to jaundice.

Her premature ovarian failure and low thyroid were indicators of autoimmune disease.

The endocrinologist ordered an ACTH stimulation test that measures the level of adrenocorticotropic hormone in the blood. ACTH is the pituitary hormone that stimulates the adrenal gland to produce cortisol, the stress or “fight or flight” hormone. The endocrinologist gave Kathy a shot of ACTH. A half hour later, the endocrinologist drew blood to test for cortisol levels. When corstisol is low, the ACTH level will be high to “whip” the adrenal into shape to make more. However if the adrenal gland is not functioning because of autoimmune destruction of the cells, then higher and higher ACTH levels still lead to low cortisol. Kathy turned out to have low cortisol levels even after the shot of ACTH.

To be continued . . .

Come back to ThirdAge.com next Thursday to find out what some people have guessed the diagnosis might be.

Marie Savard, M.D., a former Medical Contributor for ABC News and a frequent keynote speaker around the world, is one of the most trusted voices on women’s health, wellness, and patient empowerment. She is the author of four books, including one that made the Wall Street Journal list of the best health books of 2009: “Ask Dr. Marie: What Women Need to Know about Hormones, Libido, and the Medical Problems No One Talks About.” Dr. Marie earned a B.S. in Nursing and an M.D. degree at the University of Pennsylvania. She has served as Director of the Center for Women’s Health at the Medical College of Pennsylvania, technical advisor to the United Nations’ Fourth World Conference on Women in Beijing, advisor to the American Board of Internal Medicine Subcommittee on Clinical Competency in Women’s Health, health columnist for Woman’s Day magazine, and senior medical consultant to Lifetime Television’s Strong Medicine. Please visit DrSavard.com.