Describe the mechanism (steps) by which the hypothalamus/SCN and pineal gland are involved in the sleep-wake cycle in a healthy person.
Case Study for Endocrinology with Physiology class
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1.Describe the mechanism (steps) by which the hypothalamus/SCN and pineal gland are
involved in the sleep-wake cycle in a healthy person. Begin with blue light, then discuss an entire
sleep/wake cycle, ending with blue light again.
2. Given Mrs. Monroe’s mother’s condition (frequent TIA’s), the physician suspected that Mrs.
Monroe might have had a TIA in a part of her brain related to regulation of circadian rhythms.
Rule in or rule out each of the DDXs assuming that the underlying pathology is due to damage to
the Suprachiasmatic Nucleus (SCN). In other words:
• only rule in a DDX if the DDX could be caused by damage to the SCN
• if you rule out a DDX, explain how the DDX is due to a cause other than SCN damage.
3.For the DDX’s which you have ruled in, use the actigraphy log to rule in or rule out the remaining DDX’s. Explain your rationale, including what you would expect the pattern of the actigraphy log to be.
4.Mrs. Monroe’s physician is not convinced that damage to the SCN is the cause of her
condition. He would like to try one of the following treatment options to re-set her circadian
clock.
• melatonin receptor agonist (Tasimelteon) or
• bright light phototherapy in the morning (5 minutes) followed by scototherapy at night
(10 minutes). (Hint: do not google scototherapy—it is debunked information!)
For each treatment option, briefly describe the mechanism by which they would work to entrain
Mrs. M’s circadian cycle.
5.Which one would you recommend for Mrs. Monroe? Why?
