A 68-year-old woman with severe osteoporosis (T score -4.0 at the femoral neck) is seeking an alternative to bisphosphonate therapy and is interested in trying teriparatide as an injectable option.
Which of the following accurately describes a mechanism of action for teriparatide?
A 50 year-old male presents to endocrine outpatient clinic for investigation of gynaecomastia. On examination he has bilateral growth of breast tissue with palpable glandular tissue around the areolae. His past medical history includes hypertension, hypothyroidism, and congestive cardiac failure. He drinks 25 units of alcohol per week. His regular medications include: levothyroxine, amlodipine, bisoprolol, lisinopril and spironolactone.
On examination he is of normal stature, there are no peripheral stigmata of chronic liver disease or testicular masses.
What is the most likely explanation of his gynaecomastia?
A 32-year-old woman comes to you with persistent vomiting that she experiences every day. She is currently 10 weeks pregnant and has 3+ ketones in her urine. Despite taking cyclizine prescribed by her GP, she has not found any relief. You suspect that she may be suffering from hyperemesis gravidarum. In addition to administering anti-emetics and rehydration, what other medication should be recommended?
A 47-year-old man comes to the clinic for follow-up. He had presented to the emergency department two weeks ago with renal colic, which was confirmed to be nephrolithiasis through a spiral CT KUB. He was treated conservatively with IV fluids, analgesia, and an alpha-blocker, and his symptoms completely resolved before he was discharged.
Here are his blood test results:
– Hb: 142 g/l
– Platelets: 329 * 109/l
– WBC: 6.6 * 109/l
– Na+: 141 mmol/l
– K+: 3.8 mmol/l
– Urea: 6.2 mmol/l
– Creatinine: 71 µmol/l
– Corrected calcium: 2.71 mmol/l
– Parathyroid hormone: 10.2 pmol/l (normal range: 1.0-7.0 pmol/l)
What is the recommended course of action for this patient?
A 55-year-old man comes to the endocrine clinic for a check-up. He has been taking metformin and gliclazide for his diabetes, but was also prescribed a GLP-1 mimetic six months ago due to poor control. He is hesitant to start insulin because he is a truck driver and fears losing his license. Previously, he tried metformin, gliclazide, and pioglitazone, but it did not improve his HbA1c levels.
His HbA1c has only decreased from 81 mmol/mol to 80 mmol/mol in the past six months, and he has lost two kilograms. What is the best course of action?
A 67-year-old man presents to the endocrinology outpatient department with resistant hypertension and hypokalaemia. He is currently asymptomatic and has a medical history of hypercholesterolaemia. He smokes five cigarettes daily and drinks 2-3 bottles of wine per week. He is a non-executive director of a large multinational company. His blood tests reveal an increased aldosterone:renin ratio and a CT scan shows bilateral adrenal enlargement. What is the most suitable treatment for this patient?
An elderly female presents with a 2 week history of breathlessness. Her past medical history includes diet-controlled type 2 diabetes, ischaemic heart disease, hypothyroidism and depression. Her medication list includes levothyroxine, aspirin, simvastatin, ramipril, bisoprolol and citalopram. Observations on presentation to Emergency Department are as follows: respiratory rate 26/min, saturations 94% (on 4 litres oxygen via Venturi), heart rate 80 beats per minute, blood pressure 156/82 mmHg. Auscultation demonstrates crackles at the left base with no wheeze. The abdomen is soft and non-tender. There is no oedema peripherally.
Blood results on admission are provided below:
Hb 134 g/l
Platelets 172 * 109/l
WBC 13.3 * 109/l
Na+ 128 mmol/l
K+ 5.1 mmol/l
Urea 13 mmol/l
Creatinine 178 µmol/l
Serum osmolality 220 mosm/kg
Urinary sodium 50 mEq//l
What is the most likely cause of hyponatraemia in this elderly female patient?
A 72-year-old man comes to the clinic for a follow-up appointment. He was recently diagnosed with type 2 diabetes after his GP conducted a screening. Despite being advised on dietary changes, his HbA1c levels have not improved. The patient has a medical history of bladder cancer, which was treated with chemotherapy, hypertension, macular degeneration, eczema, and chronic kidney disease. His baseline eGFR is 28 ml/min/1.73m2.
Lab results:
– Na+ 139 mmol/l
– K+ 4.4 mmol/l
– Urea 6.2 mmol/l
– Creatinine 214 µmol/l
What medication would be the most appropriate to initiate?
A 75-year-old man who has smoked 20 cigarettes per day presents with a persistent cough, weight loss, and drowsiness. His test results reveal:
– Sodium (Na+): 115 mmol/l (normal range: 135-145 mmol/l)
– Potassium (K+): 5.1 mmol/l (normal range: 3.5-5.0 mmol/l)
– Urea: 3 mmol/l (normal range: 2.0-7 mmol/l)
– Creatinine: 74 µmol/l (normal range: 55-120 µmol/l)
– Plasma osmolality: 270 mOsm/kg (normal range: 285-295 mOsm/kg)
– Urine osmolality: 1210 (normal range: 500-800 mOsm/kg)
What is the most probable diagnosis?
A 26-year-old woman has been urgently referred to the endocrinology clinic due to her recent pregnancy. Despite taking oral contraceptives, she became pregnant and has been experiencing diarrhea for the past month. Her GP ordered blood tests and an antenatal referral, which revealed normal results for her full blood count, renal profile, and liver function tests. However, her TSH levels are undetectable and her free T4 levels are 52 pmol/l. Additionally, she has tested positive for thyroid-stimulating hormone receptor antibodies. The patient has no prior medical history. What is the most appropriate course of action for managing her hyperthyroidism?