Clinical Case Studies: Answers 1-29, Case Studies, Clinical Case Studies, References

This article provides answers to 29 clinical case studies, along with case studies, clinical case studies, and references. It covers topics such as antioxidants, hormones, adrenal gland conditions, and more.

CLINICAL CASE STUDIES 0
Clinical Case studies
Student Details

Running Head: CLINICAL CASE STUDIES 1
Table of Contents
Answer 1 to 29...........................................................................................................................2
Case studies..............................................................................................................................12
Clinical case studies.................................................................................................................15
References................................................................................................................................19

Running Head: CLINICAL CASE STUDIES 2
Answer 1 to 29
Answer 1
The interaction between the oxygen molecule and other substances that they may
contact, these substances may be metal or tissues. In other words, it is the process of loss of
electrons from an atom.
Answer 2
Free radicals are defined as any element or molecule capable of free existence that has
one unpaired electron in its atomic orbital. Hydroxyl radicals and nitric oxide radicals attack
the important macromolecules such as lipids, nucleic acid and proteins and leads to
hemostatic disruption and cell damage.
Answer 3
Antioxidants are substances that can be created by humans or found naturally. These
substances may prevent or reduce that cell damage. They are naturally found in fruits and
vegetable and can be taken as dietary supplements. Examples of antioxidants are: lutein,
lycopene, selenium, Vitamin A, C, and E.
The antioxidant representatives play a crucial role in preventing or inhibiting specific
factors associated with oxidative injury. But the unbalance between antioxidant defence
mechanism and oxidant species may trigger a specific factor that triggers oxidative stress
(Pisoschi & Pop, 2015).
Answer 4 Fill in the blanks
 Necrosis

Running Head: CLINICAL CASE STUDIES 3
 Abnormal ion flux
 Organelles dysfunction
 Channel protein
 Molecules
 Membrane receptors
 Nutrients
 Osmoregulation
Answer 5
Antioxidants are the molecules that prevent the effects of the free radicals by donating
an electron. This sharing of electron results in reducing the activity of free radicals. When a
free radical released or steals an electron, another radical is formed (Patekar, Kheur, Bagul,
Kulkarni, Mahalle, Ingle, & Dhas, 2013). This molecule continues to make more unstable
products. This process did not stop until the terminations occur where the radical is stabilized
by the chain breaking antioxidant like beta-carotene and vitamin C and E (Villines, 2017).
Answer 6
 Advanced Glycation End products (AGEs) are found in most tissues in the body and
their concentration increases from the age of twenty onward.
 Malondialdehyde treatment: L-Carnitine may protect the damage of cells by reducing
the levels of MDA and increasing GSH (Ates, Alp, Mumcu, Azizi, Cinici, Kiziltunc,
& Baykal, 2008).
Reactive Carbonyls produced from AGEs

Running Head: CLINICAL CASE STUDIES 4
Carbonyls are responsible for oxidative stress in the human body which leads to
aging. Antioxidants such as Vitamin E can isolate or sequester carbonyl can provide an action
against the oxidative stress (Hwang, Lee, Aldini, & Yeum, 2016).
Answer 7
A) Production of cortisol and aldosterone decreases
B) Production of aldosterone hormone reduces which takes part in low blood pressure
C) The decrease in estrogen and progesterone
D) The parathyroid production has been increased with age, which contributes to
osteoporosis (Medline Plus, 2018).
Answer 8
1. Cushing syndrome is caused by the abnormally high levels of cortisol hormone.
2. Congenital Adrenal hyperplasia is the hereditary disease which occurred due to low
production of cortisol and aldosterone.
3. Diabetes is associated with high blood sugar levels which are caused by the defect in
Insulin production (Brito, 2017).
Answer 9 (A)
Water soluble hormones
WSH attaches to receptor molecule and causes a chemical reaction inside a cell and
activates enzymes. These enzymes further either increase or decrease the speed of chemical
reactions of the cell.
Example: Adrenalin, noradrenalin, TSH, and HGH.
Fat-soluble hormones (FSH)

Running Head: CLINICAL CASE STUDIES 5
It is also known as lipid soluble. They pass through the plasma membrane and attaches
to a receptor and make hormone receptor complex which further moves to the nucleus and
attached at the binding site of DNA. This results in gene activation (on) and inactivation
(off).
Example: testosterone, progesterone, and estrogen (Ivyroses, 2018)
Answer 9 (B)
The changes occurred in endothelial eicosanoids contributes to reducing the function of
the endothelium, pathological dysfunction, and age-related heart disease. The main functions
of eicosanoids are reducing inflammation, blood clot inhibition, dilate blood vessels.
Eicocenpide also associated with diabetic nerve damage, high blood pressure, allergies, skin
inflammations and cancer.
Answer 10
1. Glucocorticoids
2. Androgens
3. Progesterone
4. Mineralocorticoids
5. estrogen (Nature, 2018)
Answer 11
 Androgen: Affects thickness of skin, wrinkle formation, skin moisture, hair growth
and sebaceous gland growth.
 DHEA: Allergic reactions of DHEA on the skin include skin redness, swelling,
itching, and rashes. It also associated with hair loss, acne and facial hair growth in
women’s (Nnama, 2017).

Running Head: CLINICAL CASE STUDIES 6
 MSH: Increased production of melanin results in skin darkness, Hyperpigmentation of
skin. Deficiency of MSH leads to loss of protection from ultraviolet rays of the sun
and inflammation (you and your hormones, 2018).
Answer 12
How Anti-ageing treatment protocols correct the stress-related hormonal imbalance
 Reduce calorie intake: calorie restriction leads to increase growth hormone
production.
 Hormone replacement therapy: It slows down the aging process. However, it has
some side effects such as carpal tunnel and edema.
 Eflornithine (Vaniqa): it helps to slow the abnormal facial hair growth in women’s by
regulating the excessive production of growth hormone
 Antiandrogen Medications: these prescription blocks androgen and helps to reduce
severe acne and abnormal hair growth (Huizen, 2018).
Answer 13
Adrenal gland conditions
 Adrenal gland fatigue: Deficiency of vitamins D, E and k leads to adrenal gland
fatigue
 Adrenal burnout: caused by low levels of macromolecules such as calcium,
magnesium potassium and sodium. Low protein intake, vitamins A, C and E and
manganese also associated with adrenal burnout (Wilson, 2018).
Answer 14
Nutrients used in antigen treatment to treat adrenal glands

Running Head: CLINICAL CASE STUDIES 7
 Vitamin D
 Vitamin E
 Vitamin K
 Protein
Answer 15
Nutrients Reference value How affects body systems
Vitamins C 45 mg/day Deficiency of Vit c causes scurvy
Niacin (B3) 16 mg/day Severe deficiency may cause Pellagra
Pantothenic Acid (B5) 6 mg/day Deficiency affects the nervous system,
energy production, and metabolism
Magnesium 330 mg/day Deficiency causes diabetes, poor
absorption, celiac and disease
Answer 16
A) Effects of hypothyroidism
 Dry hair
 Goiter
 Reduced heart rate
 Fatigue
 Dry skin
 Memory loss
Hyperthyroidism
 Hair loss
 Rapid heart rate
 Muscle weakness
 Irritability
 Nervousness

Running Head: CLINICAL CASE STUDIES 8
B) Treatments for hyperthyroidism
 Medicine such as methimazole stops the productions of thyroid
 Radioactive iodine: it is given orally either in the form of pill or liquid to ablate a
hyperactive thyroid gland
 Radioactive iodine: removal of thyroid tissue that is producing the excess hormone
(Medicine net, 2018).
Treatments for hypothyroidism
 Use of synthetic hormone levothyroxine. It restorers adequate level of hormone.
Answer 17
Effects of lifestyle and diet on hormone activity
 Excessive consumption of alcohol and sugar, contraceptive pills leads to the hormone
problem
 Emotional upset, lack of sleep, stress, aging, smoking, exposure to heavy metal such
as lead and mercury, sedimentary lifestyle lead to hormonal imbalance (Butler, 2016).
Answer 18
 Fibre rich diet can reduce the excessive level of estrogen. Lower levels of estrogen
lower the risk of breast cancer in women’s. Salmon which is rich in omega 3 fatty
acid boost testosterone level.
 Niacin intake has an effect on adrenal hormone and promotes the production of
growth hormone
 Diet rich in Pantothenic acid promotes estrogen and progesterone production.
Answer 19

Running Head: CLINICAL CASE STUDIES 9
 Cushion disease is associated with elevated level of cortisol
 Fatigue
 Weight gain
 Back pain
 Thin skin
 Blood sugar dysregulation
 High blood pressure
 Muscle wasting
 Acne
 Impaired memory (Mayoclinic, 2018)
Answer 20
 Avoid high sugar diet, caffeine, and alcohol, high amount of trans fat
 Increase intake of micronutrients, antioxidant-rich diet, consumes enough fiber and
healthy fats or protein.
Answer 21
Saliva Urine serum
Real life function of hormone
evaluated
Test results reported as: high,
low or normal
Test results show high, low
or normal levels
Multiple salivary specimens Single urine specimen Routine serum testing is
required
The collection at multiple
times allow analysis of
hormonal stress response
24-hour urine does not reflect
the stress response
serum collection requires
hospital or clinic visits
B) Blood Advantages
 A wide range of tests available
 Accepted as a high standard testing method

Running Head: CLINICAL CASE STUDIES 10
 Ideal for peptide hormones
Disadvantages
 Invasive method
 Processing of specimen required (centrifugation)
 The limitation of testing sex hormones
Answer 22
1. Liver function test
2. Full blood examination
3. Iron studies
4. TSH quantification
5. Urinalysis
Answer 23
Taking blood specimen is an invasive and testing is time, so cannot be done frequently.
Answer 24
Hormone ratios are important because they provide a straightforward way to analyze the
effects of the twin interdependent hormones.
Estriol estradiol estrone
80:10:10
Answer 25
Measuring hormone level is important for the accurate diagnosis of hormone-related
disease states which all exhibit same overlapping symptoms. It also enables one to ensure the

Running Head: CLINICAL CASE STUDIES 11
adequate balance of hormones. Inaccurate identifications of hormone level result in
inappropriate treatments (Horone Testing, 2018).
Answer 26
Aromatisation is a chemical process where the aromatic system is formed. Steroid
aromatization is a natural process where testosterone is converted into estrogen carried out by
the aromatase enzyme.
Answer 27
 Epinephrine
 Corticotrophin-releasing hormone
 Adrenocorticotropic hormone
 cortisol
Answer 28
 Dermatologist deals with skin related problem such as wrinkles, dryness and hair loss
 physiotherapist: to guide about the exercises beneficial in anti-aging
 general physician: to provide basic medicines related to blood pressure regulations
 Endocrinologist: specialist in hormones.
Answer 29
Nurses regularly perform dermal filler and injections of neurotoxin and laser treatment.
 To provide care patient had surgery
 To help the patient with medicine instructions
 To describe the precautions related to anti-aging medicines.

Running Head: CLINICAL CASE STUDIES 12
Case studies
Scenario 1
Answer 1
Aging is the natural process but it increases if diet and lifestyle of a person are
unfavorable to the body. Tina suffers stressful events because her husband left her and
married to younger women than Tina. The aging process of Tina associated with unhealthy
diet, lack of exercise and sleeplessness. She also consumes alcohol on daily basis.
Answer 2
A. Aging is associated with lack of nutrients intake, alcohol intake and lack of exercise.
Tina reported that she was taking high-calorie food and having stress during work hours
which may be the reason for accelerating aging in Tina’s case.
B. Lifestyle-related changes
Consuming foods rich in B3, B6, and B12, reducing alcohol consumption 3 drinks a
week, minimize fat intake. Yoga, dancing, and swimming might be a help to slow down
aging, improve mood, and maintain healthy BMI and keeps brain sharp.
Answer 3
Tina has acute stress which was related to her work where she sits for hours in front
of the computer and to meet the deadlines. The chronic stress she suffers was related to her
husband who left her and married to other younger women.
Answer 4
The symptoms such as mood swings, stress levels, body temperature, weight gain,
difficulty sleeping, high blood pressure, irritability, and anxiety are associated with hormonal

Running Head: CLINICAL CASE STUDIES 13
imbalance. This is due to the increased or decreases productions of hormone such as insulin,
steroids, growth hormone and adrenaline in the body.
Answer 5
 Metformin: to help manage to decrease blood sugar level.
 Hormone replacement therapy and be provided to alter the imbalanced hormone
levels
 Avoid alcohol consumption which may trigger the excess hormone production
 Regular exercises and healthy diet improves the insulin receptor sensitivity
Answer 6
As mentioned above Tina was suffering from acute and chronic stress. She was
having an unhealthy diet and irregular exercise habits. Aging is the natural process that
cannot be stopped but by adding some healthy nutrients and nutraceuticals in diet healthy
aging can be maintained. Food sources can be used as nutraceuticals to maintain the healthy
aging in Tina's case are dietary fibers, probiotics, prebiotics fatty acids polysaturated, amino
acids minerals, and peptides, vitamins, carotenoids, phytochemicals (Pérez-Sánchez,
Barrajón-Catalán, Herranz-López, & Micol, 2018).
Scenario 2
Answer 1 A)
Mr. David never exercised before he diagnosed with diabetes but at the age of 57, he
started to do excessive exercise. At this age, the body is unable to handle such pressure which
may result in excessive sweating and skin problems. He even reduced the healthy fat from his
face. Long-term insulin may be the reason for chest pain in David's case.

Running Head: CLINICAL CASE STUDIES 14
B) Recommendation
David needs to maintain the healthy fat in his body. Exercise should be limited which
his body can handle. He should drink enough water to maintain the recover the loss of water,
enough sleep, adding fruits in diet.
Answer 2
The most stress event in Mr. David's scenario was the development of angina. He was
always overweight since his childhood and it may be the stress he has all the time.
Answer 3
ACTH is the hormone that associated with aging. It stimulates the production of
cortisol from the adrenal gland. It may results in poor skin condition, weight, pain, and
insomnia. Stress may associate with stimulation of sympathetic nerves leads to excessive
sweating.
By using antiperspirant, excessive sweating can be controlled. Relaxing techniques and
meditation may help to reduce the stress.
Answer 4
Nutrients that can be added to David’s diet are proteins, water, iron, calcium, Zinc
Vitamins: A, D, E and K, Vitamin B complex and C (Clifford & Bellows, 2018).
Nutraceuticals
Bioactive peptides, bioactive polysaccharides, carotenoids, vitamin supplements and
polyunsaturated fatty acids
Analyse the principle of anti-aging medicine

Running Head: CLINICAL CASE STUDIES 15
Clinical case studies
Clinical case study 1
1. Glycation is the process by which a molecule of sugar binds to protein and lipid. The
Maillard reaction associated with AGEs where non-stable Schiff bases are formed due
to the attachment of a glucose molecule to the amino acid. Further, it leads to the
formation of ketoamine. Both Amadari product (ketoamine) and Schiff can react with
amino acid or protein to produce adducts of protein. This will undergoes oxidation,
dehydration, oxidative breakdown, polymerization and from a number of other AGEs.
2. According to the article, the glycosylation process is an enzymatic reaction and
glycation is the non-enzymatic reaction. Glycation is the pathological reaction where
AGE is the end product of the reaction and glycosylation is found to be a
physiological reaction.
3. Effects of glycation on the skin are reduced epidermal homeostasis, cell renewal, and
decrease skin contractile function, less tissue permeability, decreased elasticity and
increase in stiffness. It also associated with induction and propagation of
inflammation.
4. Extracellular proteins are the target of glycation. Collagen glycation affects its
functioning. It also causes increased stiffness and decreased flexibility. In the
intracellular protein, AGE modifies vimentin and CK10 in keratinocytes. Enzymes
and growth factors are the targets.
5. Topical and edible ingredients such as aminoguanidine, Pyridoxamine, age breaker
chemicals like dimethyl-3-phenyl-thiazolium chloride and FAOX enzyme.
Nutraceuticals such as ascorbic acid, niacinamide, trolex, riboflavin, zinc, manganese,
selenium yeast and trolox can help to inhibit in vitro glycation of albumin.

Running Head: CLINICAL CASE STUDIES 16
6. Anti-aging Strategies
A. Substances like Aminoguanidine and pyridoxamine helps top prevent or inhibit
the formation of AGE.
B. Age breakers such as ALT-711, N-Phenacylthiazolium, and N- phenacyl—4, 5-
dimethyl thiazolium break the Maillard reaction.
C. Nutraceuticals such as Trolox, niacinamide, pyridoxal, sodium selenite, selenium
yeast inhibits glycation.
D. By restricting calorie intake prevent accumulation of AGE
E. Antagonism of RACE is also helpful to reduce accumulation of AGE. Gene
knockdown of RACE by using siRNAs (Gkogkolou & Böhm, 2012).
Clinical case study 2
1. In the stress event hypothalamus secrets CRH, this will further stimulate the pituitary
gland to produce POMC peptides which includes ACTH, Adrenal gland then secretes
GC and Catecholamines. In the response of these events, sebaceous gland produces
CRH and prolactin, in nerve endings, secrete SP and catecholamine’s, dermal
fibroblast secrets cortisol, epidermal keratinocytes, and melanocytes secretes CRH
and Nts.
2. Atopic dermatitis is a skin disease associated with eczema and itching. The key
features of an AD are skin barrier and function defect. Stress negatively impairs the
permeability barriers function of the skin and also impacts homeostatic. Stress can is
also suspected to trigger acne flares. Psoriasis exacerbation also associated with
stress, the psoriasis stress affects skin peripheral HPA and SAM axis.
3. Pro-inflammatory signals such as cytokinesis cause oxidative damage to the cells and
tissues, debris release. Psoriasis is associated with chronic skin inflammation leads to

Running Head: CLINICAL CASE STUDIES 17
hyperplasia. Chronic inflammation also leads to dysfunction of protein, cell and organ
and these changes contribute to aging.
4. Epinephrine binds to adrenergic receptors leads to decrease inflammation functions of
the skin. NGF also contributes to allergic and neurogenic inflammation. Substances P
or SP induces the release of cytokinesis leading to the proliferation of T cell and
inflammation.
5. Anti-inflammatory medicine may help to reduce chronic inflammation. Taking low
doses of anti-inflammatory medicine such as Aspirin may decrease inflammation.
Glutathione is an antioxidant that has the efficacy to control severe forms of
inflammation. Vitamin A, C, D, K, and E have treated all inflammatory condition.
6. The author suggests sleep deprivation can affect the skin because lack of sleep may
cause fine lines, pigmentations, and decreased the elasticity of the skin. Sleeplessness
also associated with slow recovery from skin disruption. These symptoms are directly
related to aging (Chen, & Lyga, 2014).
Clinical case study 3
1. Some of the sites like promoter-associated CpG islands that shows low DNA
methylation tend to induce Methylation with age, while the person with increased
DNA methylation like intergenic island tends to decrees methylation with the age.
2. Biochemical pathways associated with methylation are folate cycle where THF
(tetrahydrofolate) changes to 10 formyls THF in the presence of DHFR. At this
stage, purine is synthesized. The 10 formyl THF is then transformed in 5, 10
methylene THF in the presence of MTHFR and Riboflavin and further results in 5
MTHF. Another pathway is transsulfuration pathway where homocysteine
changes to cysteine.

Running Head: CLINICAL CASE STUDIES 18
3. Epigenetic drift is described as the collection of epigenetic changes occurs with
age, which could be related to a person's unique environment.
Epigenetic clock reflects the aging process. It occurs due to the increasing
variability which is caused by epigenetic drift.
4. Epigenetic drift and the epigenetic clock used as a marker to understand to the
aging process in a particular person so that the treatments can the applied
accordingly. DNA methylation can be sued as age predictor. Epigenetic age could
be helpful to assess intervention or treatments.
5. Findings of this studies related to the link between DNA methylation, epigenetic
drift, and epigenetic drift can be helpful to discover new treatment for age-related
problems. The results about the biochemical pathways related to methylations
show that the aging process can be reduced by altering some pathways that
accelerate aging.
6. According to Wilson, it was found that ALU and Line-1 elements exhibit
decreased reduced methylation levels and increase in variability with age.
7. Most important nutrient in DNA methylation pathways is folate and B12. Some
other nutrients such as cysteine, DHA, zinc, magnesium, riboflavin, niacin and
choline also play a role in therapeutic treatment (Jones, Goodman, & Kobor,
2015).

Running Head: CLINICAL CASE STUDIES 19
References
Ates, O., Alp, H. H., Mumcu, U., Azizi, S., Cinici, E., Kiziltunc, A., & Baykal, O. (2008).
The effect of L-carnitine treatment on levels of malondialdehyde and glutathione in
patients with age-related macular degeneration. The Eurasian journal of
medicine, 40(1), 1.
Brito, J. (2017). Everything you should know about hormonal imbalance. Retrieved from:
https://www.healthline.com/health/hormonal-imbalance
Butler, N. (2016). How your diet affects your hormones during menopause. Retrieved from:
https://www.healthline.com/health/menopause/diet-hormones#5
Chen, Y., & Lyga, J. (2014). Brain-skin connection: stress, inflammation and skin
aging. Inflammation & Allergy-Drug Targets (Formerly Current Drug Targets-
Inflammation & Allergy), 13(3), 177-190.
Clifford, J. & Bellows, L. (2018). Nutrition and Aging. Retrieved from:
http://extension.colostate.edu/topic-areas/nutrition-food-safety-health/nutrition-and-
aging-9-322/
Custommedicine (2018). Hormone Testing. Retrieved from:
https://custommedicine.com.au/hormone-analysis/
Gkogkolou, P., & Böhm, M. (2012). Advanced glycation end products: key players in skin
aging?. Dermato-endocrinology, 4(3), 259-270.
Huizen, J. (2018). What to know about hormonal imbalance. Retrieved from:
https://www.medicalnewstoday.com/articles/321486.php

Running Head: CLINICAL CASE STUDIES 20
Hwang, S. W., Lee, Y. M., Aldini, G., & Yeum, K. J. (2016). Targeting reactive carbonyl
species with natural sequestering agents. Molecules, 21(3), 280.
Ivyroses (2018). Water soluble hormones VS fat-soluble hormones. Retrieved from:
http://www.ivyroses.com/HumanBody/Endocrine/Hormones-solubility.php
Jones, M. J., Goodman, S. J., & Kobor, M. S. (2015). DNA methylation and healthy human
aging. Aging cell, 14(6), 924-932.
Jones, M. J., Goodman, S. J., & Kobor, M. S. (2015). DNA methylation and healthy human
aging. Aging cell, 14(6), 924-932.
Mayoclininc (2018). Cushing syndrome. Retrieved from:
https://www.mayoclinic.org/diseases-conditions/cushing-syndrome/symptoms-causes/
syc-20351310
Medicine Net (2018). Hyperthyroidism symptoms, cause, treatment, and diet. Retrieved from:
https://www.medicinenet.com/hyperthyroidism/article.htm#hyperthyroidism_definition
_and_facts
Medline Plus (2018). Aging changes in hormone production. Retrieved from:
https://medlineplus.gov/ency/article/004000.htm
Nature (2018). Steroid hormones. Retrieved from: https://www.nature.com/subjects/steroid-
hormones
Nnama, H. (2017). DHEA harmful effects. Retrieved from:
https://www.livestrong.com/article/225970-dhea-harmful-effects/
Patekar, D., Kheur, S., Bagul, N., Kulkarni, M., Mahalle, A., Ingle, Y., & Dhas, V. (2013).
ANTIOXIDANT DEFENCE SYSTEM. Oral & Maxillofacial Pathology Journal, 4(1).

Running Head: CLINICAL CASE STUDIES 21
Pérez-Sánchez, A., Barrajón-Catalán, E., Herranz-López, M., & Micol, V. (2018).
Nutraceuticals for skin care: A comprehensive review of human clinical
studies. Nutrients, 10(4), 403.
Villines, Z. (2017). How do free radicals affect the body?. Medicine News Today. Retrieved
from: https://www.medicalnewstoday.com/articles/318652.php
Wilson, L. (2018). Adrenal Burnout Syndrome. Retrieved from:
https://www.drlwilson.com/articles/adrenal_burnout.htm
You and Your Hormones (2018). Melanocyte-stimulating hormone. Retrieved from:
http://www.yourhormones.info/hormones/melanocyte-stimulating-hormone/
Pisoschi, A. M., & Pop, A. (2015). The role of antioxidants in the chemistry of oxidative
stress: A review. European journal of medicinal chemistry, 97, 55-74.