instruction: hello doctor patient is a 35 year old woman many years ago she suffered from increased perspiration during night from the child when year old this was continuous making several changes of clothes a day necessary the situation was worse during physical or emotional stress in addition she had polydipsia but urine volumes were normal she was underweight even though she had polyphagia and was with tiredness and asthenia the latter was increased in recent years she tried many treatment types but none successful and improvement in her condition was not seen by the time the patient was 37 keg 160 am and was eating 0 500 calories per day her blood pressure was normal with 100 beats per minute her temperature was 36 8c 37 8c but sometimes rose to as high as 38 4c no thyearoid toxicity or thyearoid gland enlargement was present normal blood tests except for an elevated 24 hour urine creatinine but it was noted that her basal metabolic rate varied between 140 and 210 percent above normal specimens of muscle tissue were taken under local anesthesia from the patient the latter showed that respiration could proceed at a nearly maximal rate in the absence of add when add was supplied in excess phosphorylation to produce at proceeded as normal I have to diagnose this patient but I am in a dilemma because I think that from the details I have for her as mentioned above the biochemical pathway that is likely to be dysfunctional is glycolysis or glucose I am more towards the thought that she has a dysfunctional glycolysis pathway am I right for this or not what do you think also can you please suggest me what might be the underlying cause for the symptoms of hypermetabolism seen at her and what can be an evolutionary advantage for her
output: hi I have gone through your case details I am with your thought process of diagnosis let us try symptom analysis and the clinical syndrome that patient has the major symptom is hyperhidrosis that is increase sweating this can be due to primary hyperhidrosis or secondary hyperhidrosis this is less likely primary hyperhidrosis generalized sweating is mostly due to an underlying systemic illness or as a side effect of medication while focal sweating is generally due to a neurologic disorder or primary hyperhidrosis in this case it is generalized sweating we need to find out are there signs and symptoms of infection acute or chronic neoplasia metabolic endocrine disease diabetes thyearoid pheochromocytoma carcinoid high catecholamine state respiratory failure heart disease pain drug etoh withdrawal drug therapy propranolol antidepressants pilocarpine physostigmine neurologic disease dysautonomia diencephalic epilepsy hypothalamic lesion structural brain abnormality in your case it has a high metabolic rate with the childhood onset disease process so metabolic endocrine and high catabolic state is likely diagnosis in the metabolic it is more mitochondrial metabolic disorder likely diagnosis the mitochondrial damage results in defects in the electron transport chain can affect any tissue tissues requiring the highest levels of energy production are the most severely affected certain red flags which should immediately increase the suspicion of a mitochondrial disorder these include short stature neurosensory hearing loss progressive external ophthalmoplegia axonal neuropathy diabetes mellitus hypertrophic cardiomyopathy and renal tubular acidosis hope this insight will help you primary hyperhidrosis secondary hyperhidrosis metabolic myopathy mitochondrial disorder electron chain transfer morgan syndrome autoimmune serum lactate muscle biopsy for metabolic myopathy mitochondrial disorder genetic analysis mitochondrial disorder as per diagnosis antioxidants vitamin and riboflavin avoid excessive exercise to keep hydrated