A 25-year-old woman with a history of partial Kallmann syndrome presents to the fertility clinic seeking advice on starting a family. She has been married for 6 months and has normal external genitalia, sparse pubic and axillary hair, and a body mass index of 23kg/m². What is the most suitable course of action for her?
A 60-year-old man with a 35-year history of type 1 diabetes mellitus presents to the clinic for follow-up. He has peripheral diabetic sensory neuropathy, impotence, and has undergone laser therapy for bilateral diabetic retinopathy. His primary concern is experiencing unpredictable vomiting of undigested food, despite dietary modifications. During a previous hospitalization, erythromycin was effective in treating the condition. A barium swallow revealed significantly prolonged gastric emptying.
What is the most suitable long-term management plan for this patient?
A 17-year-old male patient comes to the clinic with complaints of inadequate development of secondary sexual characteristics. Upon examination, you observe insufficient testicle growth and minimal axillary and pubic hair.
The blood test results are as follows:
Testosterone 2.5 nmol/L (6 -27)
FSH 4.2 IU/L (1.8 – 22.5)
LH 3.1 IU/L (1.2 – 103)
What is the probable diagnosis?
A 42-year-old man presents to the Neurology clinic for assessment. He has a history of migraine with aura and is currently taking topiramate. No other medications are being taken. The following investigations were conducted:
– Na+ 138 mmol/L (135 – 145)
– K+ 3.1 mmol/L (3.5 – 5.0)
– Urea 5.7 mmol/L (2.0 – 7.0)
– Creatinine 78 µmol/L (55 – 120)
Venous blood gas:
– pH 7.29 (7.35 – 7.45)
– Bicarbonate 16 mmol/L (22 – 29)
Urinalysis:
– Glucose 3+
– Protein 2+
– Blood negative
What is the most likely diagnosis?
A 45-year-old woman presents with a history of recurrent lethargy, shakiness, slurred speech, and diplopia for the past year. Her symptoms usually occur in the mornings and resolve after breakfast. She has a medical history of type 2 diabetes mellitus, alcohol excess, and a functional neurological disorder.
Upon observation, her SpO2 is 97% on room air, respiratory rate is 22 breaths/minute, blood pressure is 92/64, heart rate is 116 beats per minute, and she is apyrexial. Her capillary blood glucose is 5.2, but during the review, she becomes shaky and feels unwell. A repeat blood glucose test shows 2.4.
Blood tests are ordered, and 40% dextrose gel is administered. The results of the blood tests show insulin levels of 43 pmol/L (<25), C-peptide levels of 114 pmol/L (<75), and pro-insulin levels of 23 pmol/L (3.6-22). What is the most likely diagnosis?
A 35-year-old male with a history of asthma and HIV visits the HIV clinic for a check-up. He has been experiencing weight gain, marks on his abdomen, and his partner has noticed a more heavy-set appearance in his face over the past two months. He was diagnosed with HIV at 21 years old after sharing needles and using heroin. He has been on retroviral treatment since he was 22, taking tenofovir, emtricitabine, atazanavir, and ritonavir, and has had good control. His asthma has been well managed with only salbutamol until six months ago when he started taking regular fluticasone due to recurrent exacerbation from upper respiratory tract infections. His recent blood tests show an undetectable viral load and a CD4 count of 900 cells/microliter. What is the most likely explanation for his symptoms?
A 20-year-old woman presents to her GP with a 6 month history of weight loss, diarrhoea and palpitations. The diarrhoea is normal colour and over the last two months she has had roughly 2-3 bowel motions per day. The heart palpitations occur randomly throughout the day and night. She has also noticed that she has recently been getting episodes of feeling very hot and sweaty. She has no other past medical history and her only family history is a mother who has Hashimoto’s thyroiditis.
On examination, the patient is sweaty and her blood pressure is 130/80 mmHg, pulse is 102 bpm and regular, respiratory rate is 16/min and her oxygen SATs are 98% on air.
Blood tests are performed and reveal:
Hb 135 g/l
Platelets 220 * 109/l
WBC 7.1 * 109/l
Na+ 139 mmol/l
K+ 3.9 mmol/l
Urea 5.1 mmol/l
Creatinine 60 µmol/l
Free thyroxine (T4) 28 pmol/l
Thyroid stimulating hormone (TSH) 0.08 mu/l
A thyroid radioisotope scan is performed and reveals a globally reduced uptake.
What is the most likely diagnosis?
A 40-year-old woman presents to the Endocrinology Clinic with a 4-month history of amenorrhoea. She reports having to wax her arms and upper lip and her mother went through early menopause at 28 after having an emergency hysterectomy post-partum. On examination, her body mass index is 38 kg/m² but otherwise unremarkable. Her GP has ordered blood tests prior to her appointment. Based on the following results, what is the most likely diagnosis?
Investigations:
LH 40 IU/L (5 to 25 IU/L)
FSH 8 IU/ (1 to 11 IU/L)
Estradiol 720 pmol/L (70-500 pmol/L)
Progesterone 220 nmol/L (35-92 nmol/L)
Thyroid Stimulating Hormone 5.6 mIU/L (0.5 -6.0 mIU/L)
Prolactin 700 mIU/L (105-548 mIU/L)
A 32-year-old woman presents to your clinic with complaints of weight gain and irregular periods. Upon examination, her heart rate is 95 bpm and blood pressure is 155/92 mmHg. Her lab results show a low Hb level of 110 g/L, high MCV of 112 fl, and platelets within normal range at 199 * 109/L. Bilirubin and ALP levels are elevated at 17 µmol/L and 138 u/L, respectively, while ALT is slightly elevated at 55 u/L. Cortisol levels are high throughout the day, with a 9AM level of 461 nmol/L, midnight level of 154 nmol/L, and a rise to 645 nmol/L following an insulin stress test. Urine free cortisol is also elevated at 802 nmol/24h, while ACTH is within normal range at 13.3 pmol/L. Imaging studies show fatty changes in the liver but are otherwise unremarkable. What is the most likely diagnosis for this patient?
A 23-year-old woman with a history of type 1 diabetes presents to the Emergency department. She has been experiencing a viral upper respiratory tract infection that has worsened over the past three days, and her latest BM estimation shows her glucose has risen to 33 mmol/L. On examination, she has a fever of 37.9°C, a BP of 100/60 mmHg, and a pulse of 95. She has signs of pharyngitis and a cough, and her respiratory rate is elevated at 30.
Investigations reveal a haemoglobin level of 119 g/L, a white cell count of 10.2 ×109/L, platelets of 220 ×109/L, sodium of 139 mmol/L, potassium of 4.5 mmol/L, creatinine of 132 µmol/L, bicarbonate of 14 mmol/L, pH of 7.15, and glucose of 38.1 mmol/L.
What is the appropriate management for her diabetic ketoacidosis (DKA)?