Posted January 21, 200916 yr If any of the mods feel like this is cluttering the forum, feel free to move it to flames forum as needed. Patient, 37 year old male admitted to the hospital with a multitude of symptoms. He came in complaining about pain in his loin region, weakness, and dark colored urine. Upon physical examination, the patient's blood pressure was 220/100, heart rate was 150 bpm. A small mass was detected upon deep palpation of the upper left abdominal quadrent. Also, examination of the eyes with an opthalmoscope demonstrated a small unusual mass. Labs were ordered and came back with the following significant results: Elevated levels of catecholamines BUN 110 (Elevated) Creatinine 4.1 (Elevated) Hemoglobin 6.2 (Low) RBC 3.1 (Low) erythropoietin 5.1. (Low) We do a CT scan of the upper abdominal region and found that there wasn't just one, but multiple masses located in the left kidney and also in the left adrenal gland located immediately superior to the kidney. Patient denies taking any medication other than tylenol for fever due to the occasional flu or cold. Patient works in software engineering and although he says he tries to maintain a healthy diet, he admits to not getting as much exercise as he should. Family History: Patient does not have any siblings. His father died from myocardial infarction at the age of 80 and his mother died from renal cell carcinoma when the patient was only a child. Since I don't have as much time anymore as when I was on break, I've posted pretty much enough information that with research, you can determine the final diagnosis. Once again, if you ask for any tests or details, I'll provide the results. So, what's your differential diagnosis?
January 21, 200916 yr Author AIDS No significant drop in white blood cell count in the lab results, no drop in CD4 cell count.
January 21, 200916 yr Renal failure, a fucked liver? a fucked gallblatter?, cancer of some kind his BUN level is not in normal limits.. kidneys are shot.. his organs are all dieing slowly spreading tumors maybe sarcoidosis? Edited January 21, 200916 yr by [myg0t]B34V3RS
January 21, 200916 yr Author He probably drank too many protein shakes or energy drinks. Protein shakes would explain the elevated BUN levels, but not any of the other test results. Caffeine from energy drinks could raise blood pressure and heart rate, but won't explain any of the other symptoms.
January 21, 200916 yr No significant drop in white blood cell count in the lab results, no drop in CD4 cell count. What about his carbohydrate levels?
January 21, 200916 yr Author CJ;606077']Renal failure' date=' a fucked liver? a fucked gallblatter?, cancer of some kind his BUN level is not in normal limits.. kidneys are shot.. his organs are all dieing slowly spreading tumors[/quote'] Renal failure explains the elevated BUN and creatinine. However, considering how he has tumors growing all over his kidneys, it's more than likely that the tumors are the cause of his renal failure. Gallbladder obstruction would lead to elevated conjugated bilirubin levels, while this patient doesn't demonstrate elevated bilirubin or jaundice. So far, metastasizing tumors are a possibility but it doesn't explain how his blood pressure and catecholamine levels are through the roof.
January 21, 200916 yr Author What about his carbohydrate levels? 8 hour fasting glucose level of 80 mg/dl (normal) and 2-hour oral glucose tolerance test of 120 mg/dl (normal). He's not diabetic.
January 21, 200916 yr Renal Cell Carcinoma or Neuroepithelial Tumors with Sarcoidosis Edited January 21, 200916 yr by [myg0t]B34V3RS
January 21, 200916 yr Author CJ;606085']Renal Cell Carcinoma or Neuroepithelial Tumors ? Biopsied the tumors in the kidney, pathology found that they were consistent with renal cell carcinoma. We've determined the cause of the elevated BUN and creatinine. But the patient's severely elevated blood pressure and elevated levels of catecholamines is still a mystery.
January 21, 200916 yr Author CJ;606087']so hes in s-tachy he is 34 what is his normal bp? Normal BP for a typical person is 120/80. He reports that he doesn't really go to the doctors that often and until recently, he hadn't gotten his BP checked in years. Last time he had it checked, he said it was around 110/75
January 21, 200916 yr Author Pheochromocytoma. Pheochromocytoma, not a bad idea. Cancer of the adrenal gland would explain the huge excess of catecholamines in his blood and his severely elevated blood pressure. It's very unlikely that he would have two different kinds of cancers at the same time, but for the sake of being sure, a biopsy of the masses in the left adrenal gland was done, and sure enough, pathology confirmed that it was consistent with pheochromocytoma. So, we have a patient that has two different types of cancers simultaneously. They explain all of the symptoms except for the fact that he has an additional mass in his eyes. Even if we were to explain that by metastasis, it is still extremely rare for someone to have multiple tumorous masses growing on two different organs, both of which are confirmed to be of a different type of cancer. Any ideas?
January 21, 200916 yr Author CJ;606097']my final hypothesis is DEATH lol If these tumors keep popping up, you're probably not that far off.
January 21, 200916 yr Pheochromocytoma, not a bad idea. Cancer of the adrenal gland would explain the huge excess of catecholamines in his blood and his severely elevated blood pressure. It's very unlikely that he would have two different kinds of cancers at the same time, but for the sake of being sure, a biopsy of the masses in the left adrenal gland was done, and sure enough, pathology confirmed that it was consistent with pheochromocytoma. So, we have a patient that has two different types of cancers simultaneously. They explain all of the symptoms except for the fact that he has an additional mass in his eyes. Even if we were to explain that by metastasis, it is still extremely rare for someone to have multiple tumorous masses growing on two different organs, both of which are confirmed to be of a different type of cancer. Any ideas? He simply has been developing cataracts without noticing.
January 21, 200916 yr Author He simply has been developing cataracts without noticing. Cataracts is the clouding of the lens in the eye, not a mass seen in the back of the eyes. Also, even if it was cataracts and not a tumor, it still wouldn't explain how the patient has two different types of cancer simultaneously. The chances of that are extremely rare.
January 21, 200916 yr Pheochromocytoma, not a bad idea. Cancer of the adrenal gland would explain the huge excess of catecholamines in his blood and his severely elevated blood pressure. It's very unlikely that he would have two different kinds of cancers at the same time, but for the sake of being sure, a biopsy of the masses in the left adrenal gland was done, and sure enough, pathology confirmed that it was consistent with pheochromocytoma. So, we have a patient that has two different types of cancers simultaneously. They explain all of the symptoms except for the fact that he has an additional mass in his eyes. Even if we were to explain that by metastasis, it is still extremely rare for someone to have multiple tumorous masses growing on two different organs, both of which are confirmed to be of a different type of cancer. Any ideas? He's been exposed to something. Plain and simple. Examine his place of employment.
