Module 6: Hormones
Question 1: Alice is a 70 year old woman with low vitamin D levels who recently broke a hip. She has osteoporosis. She was given several medications to try to improve bone density, however, they were unsuccessful as she could not tolerate the medications. What hormone might she be given to treat the osteoporosis? How does this medication help? How would this be effected by a low TSH?

Osteoporosis is a disease in which excessive loss of calcium from the bones occur without adequate replacement, due to the calcium loss bones become weak and are more likely to break (Scanlon & Saunders, pg 129b). Estrogen is classified as a sex hormone but it is also essential for female bone health because it promotes the activity of osteoblasts. Estrogen supplementation is a form of hormone replacement therapy that is approved by the FDA in the treatment of osteoporosis because it slows down bone loss and increases bone density. Estrogen supplementation may lower TSH levels in women with hypothyroidism triggering hypothyroid symptoms, such as low energy and feeling tired, sluggish, and cold, or to put them at risk for regrowth of thyroid cancer. While using estrogen supplements patients thyroid panel should be monitored routinely and doses of thyroid hormone medication adjusted appropriately.

Question 2: Darren is a 15 year old, tall for his age, but he wants to build more muscle. He decides that he will eat only protein foods, because he says, “muscle is protein, so protein will make protein, and the more protein, the more muscle.” In part he is correct, and in part incorrect. Explain, and name the hormones involved in protein metabolism; state how each affects protein metabolism.

Since Darren is 15 years old his production of growth hormone (also known as somatotropin) is elevated due to his age (Scanlon & Saunders, pg 259). Growth hormone causes the increase use of fats for energy and increases the rate of protein synthesis. Since Darren is eating only protein he will become nutritionally malnourished which will leave him easily fatigued and not able to train as well as he’s hoping for. Darren should seek the help of a dietician or other professional for a diet plan that will assist him in gaining muscle but not deprive his body of essential nutrients.

Question 3: Kay and Lucia are best friends and enjoy spending time together over the holidays decorating and preparing for visits by their extended family. Kay recently visited her physician for an annual check-up and received news that she was pre-diabetic and that she should monitor her calorie intake, especially with the holidays close at hand. Kay was troubled by the news but Lucia was even more so since she had been admonishing Kay for unhealthy eating and exercise habits for years. Lucia was also particularly distressed because she has worn an insulin pump since she was nine years old. Kay’s remark about the news was, “Well, Lucia, this is great, now I can be even more like you!”
Using your knowledge of the endocrine system explain how Kay’s comment is correct but also how the types of diabetes they each have (or are at risk of having in Kay’s case) differ. What nutrition and exercise related habits might put Kay at increased risk for developing diabetes? How can healthcare providers help Kay reduce her risk of diabetes?

Lucia has diabetes mellitus - type 1, this is indicated with the use of insulin as a child(Scanlon & Saunders, pg 267). Kay is pre-diabetic which signifies that because of her poor diet and exercise habits her body is producing insulin but not enough to cover the amounts of carbohydrates and high sugar foods she is consuming. If she continues to eat poorly and not exercise Kay will develop diabetes mellitus - type 2 which will require her to monitor her blood sugar levels more frequently and require her to have medication interventions in place to regulate her blood sugars. Her healthcare provider can recommend diabetic diet. If her insurance cover it the HCP may also refer her to a dietician that will be able to work with Kay over several sessions on educating her on a strict diet that regulates her intake of sugar and complex carbohydrates. Her HCP should also recommend an exercise regimen that will help her burn calories over what she is consuming. In a recent con-ed class I attended on diabetes the educator explained that the human body can safely handle blood sugar levels up to 200 anything over that the body is not able to store and thus excretes it out through the bladder placing the patient at higher risks for urinary tract infections. Also, the excess sugar in the blood tries to find a way out through nerve endings in the head and legs which damages those nerves which is the reason why patients with diabetes develop eye problem and diabetic neuropathy.

References
Scanlon, V., & Sanders, T.(2015). Essentials Of Anatomy and Physiology. 7th Edition.
Philadelphia, Pennsylvania: F. A. Davis Company
Healthy Women. (2015) Estrogen. Obtained From: http://www.healthywomen.org/condition/estrogen LiveStrong. (2008) Disadvantages of a High Protein Diet. Obtained From:
http://www.livestrong.com/article/92491-disadvantages-high-protein-diet/