The patient, a 42-year-old male, presented with a 17 pound weight gain over the past month, lethargy, and an enlarged liver. Laboratory results found excessive glycogen in the liver, abnormal fat metabolism, and low testosterone levels. The diagnosis determined the smooth endoplasmic reticulum was malfunctioning, impacting calcium balance and testosterone, glycogen, and fat levels. This caused multiple symptoms by disrupting the smooth ER's roles in lipid synthesis, detoxification, and calcium storage.

1. Case Study #4
Julia Burton and Maria Chiaffarano

2. PATIENT HISTORY
• 42 year old male
• No major health issue to date
• Notable increase in weight over past month – gain of 17 pounds
• Recent lethargy
• Patient is on a new eating regimen – every meal is from a ‘fast food’
restaurant

3. PHYSICAL EXAMINATION
• Enlarged liver
• Muscle weakness

4. LABORATORY RESULTS
• Negative for hepatitis
• Excessive glycogen granules in liver
• High levels of fat in liver – abnormal fat metabolism
• Low testosterone levels
• Abnormal cell calcium balance

5. DIAGNOSIS
The organelle that is malfunctioning is the
Smooth ER

6. RATIONALE FOR DIAGNOSIS
Fatigue/Abnormal cell calcium balance
• Calcium pumps are not operating properly
• The storage/balance of calcium is not working correctly (maintaining
concentration process)
• Calcium pumps maintain low levels for cell signaling
• This could be the reason why muscle contraction is causing fatigue.

7. RATIONALE FOR DIAGNOSIS
(CONT.)
Possible reasons for the enlarged liver:
• Cancer
• Heart diseases
• Liver disease
• Cirrhosis

8. RATIONALE FOR DIAGNOSIS
(CONT.)
Increase in weight
• The current “fast-food” diet is a factor of the weight gain. Fast food
has a lot of fat that is bad for the body in it. The excessive intake of
fast food increases body weight.
• Weight gain can also be caused by nutritional imbalances (increase in
fat and sugar)

9. RATIONALE FOR DIAGNOSIS
(CONT.)
Low Testosterone levels
• Testosterone is made up of steroids which are fats
• The smooth ER is involved in lipid synthesis (making of fat) and
therefore would affect levels of testosterone if there is a smooth ER
problem

10. RATIONALE FOR DIAGNOSIS
(CONT.)
Excessive glycogen granules in the liver/Enlarged liver
• Glycogenoses are resulted from abnormal metabolism of glycogen
or the lack of a particular lysosomal enzyme to degrade glycogen or
catabolism of glucose
• Results in excess glycogen
• The liver and heart can also be affected

11. GENERAL DIAGNOSIS
The patient’s symptoms cannot be classified as a single
disease. The smooth ER is causing multiple problems,
especially with his liver and fats because the smooth ER
is responsible for lipids and detoxifications and calcium
storage.