A 27-year-old female presents with galactorrhoea. She denies experiencing any other symptoms during systematic enquiry and has no past medical history or regular medication use. Upon blood testing, the following results were obtained: FSH 0.2 mIU/ml (normal 1 – 8), LH 0.5 mIU/ml (normal 1-18), oestradiol 482 pg/ml (normal 27 – 123), progesterone 46 ng/mL (normal 5 – 20), and prolactin 82 ng/dL (normal 5 – 40). What further investigation would you recommend?
A 19-year-old male with no previous medical history presents to the Emergency Department’s resuscitation room for evaluation. Upon assessment, he is found to be febrile, tachycardic, and hypotensive. A widespread, non-blanching, purple rash is also observed. The diagnosis is meningococcal septicaemia, and appropriate treatment is administered. However, the patient’s condition worsens as he develops Waterhouse-Friderichsen syndrome. Which of the following blood test results would be most indicative of his current state?
A 45-year-old female presents with palpitations and mild weight loss. She has no significant medical history but regularly takes supplements from a health food shop. She does not smoke and drinks alcohol infrequently. Her maternal aunt has a history of underactive thyroid, but otherwise, there is nothing noteworthy in her family history.
During examination, her pulse is 96 beats per minute, and her blood pressure is 122/76 mmHg. She exhibits fine tremors in her outstretched hands and slight lid lag, but no exophthalmos or goitre is palpable.
Thyroid function tests reveal:
– Free T4: 29.3 pmol/L (normal range: 10 – 22)
– Free T3: 5.3 pmol/L (normal range: 3.5 – 5.5)
– TSH: <0.02 mU/L (normal range: 0.4 - 5.0)
– Thyroglobulin: Undetectable
What is the most likely diagnosis?
A 65-year-old lady presents for a follow-up appointment. She had presented 6 months previously under the acute medical take with headaches, sweating, abdominal pain and wild fluctuations in blood pressure. She is currently being followed up by the appropriate surgical team and her symptoms are currently well controlled with medical treatments. On examination today, you note a lump in her anterior neck and you are given the following blood tests:
Calcium (corrected) 3.68 mmol/l
Phosphate 0.38 mmol/l
Vitamin D3 115 nmol/l (75-200 nmol/l)
Parathyroid hormone 19 pmol/l (0.8 – 8.5 pmol/l)
You have referred the patient to endocrine surgeons for neck biopsies and urgent review. Her daughter, who came with her to the consultation, is worried about her own risk of developing similar symptoms in the future. What advice can you offer the daughter?
A 35-year-old woman presents to her GP with a three-month history of frequent loose stools and occasional episodes of facial flushing. She has no significant medical history, has not traveled recently, and is not taking any medications. On examination, she appears dehydrated and is referred to the hospital’s AMU.
Upon admission, blood tests reveal the following results:
Arterial pH 7.33 7.35 – 7.45
Arterial pCO2 4.5 kPa 4.7 – 6.0 kPa
Arterial pO2 13.8 kPa > 10.5 kPa
Arterial HCO3 17.8 mmol/l 22.0 – 26.0 mmol/l
Sodium (Na+) 139 mmol/l 135 – 145 mmol/l
Potassium (K+) 3.2 mmol/l 3.5 – 5.0 mmol/l
Urea 6.8 mmol/l 2.5 – 6.5 mmol/l
Creatinine (Cr) 91 μmol/l 50 – 120 μmol/l
Calcium (Ca2+) 2.72 mmol/l 2.2 – 2.7 mmol/l
Magnesium (Mg2+) 0.47 mmol/l 0.6 – 1.1 mmol/l
Further investigations reveal a negative stool culture for bacterial and fungal infections, and a CT scan shows a lesion on her pancreas.
What is the most likely diagnosis?
A 20-year-old man is being discharged after a five-day inpatient stay for diabetic ketoacidosis and a new diagnosis of type 1 diabetes mellitus. He received education on managing his diabetes and insulin at home, but he is unsure about his target plasma glucose levels after meals. What is the recommended target for home monitoring?
A 32-year-old pregnant woman at 10 weeks gestation seeks advice on how to rule out gestational diabetes. She has a BMI of 28.7 and a family history of type 1 diabetes in her cousin and breast cancer in her aunt. She has had two previous pregnancies, one of which ended in miscarriage at 8 weeks and the other resulted in a healthy baby with a birth weight of 4.6kg. What testing regimen would be most appropriate for ruling out gestational diabetes in this patient?
A 27-year-old woman with a history of hypertension resistant to dual therapy presents to the Endocrine Clinic. She also has a history of asthma for which she takes a Chinese herbal remedy and a fluticasone/salmeterol inhaler. On examination, her blood pressure is 162/95 mmHg, and investigations reveal low potassium levels and elevated bicarbonate levels. Which of the following is the most likely diagnosis?
A 50 year-old woman presents with a two day history of nausea and fever. On admission she is confused and her husband states that she was recovering from a recent upper respiratory tract infection and sore throat. He also mentions she has previously been experiencing episodes of diarrhoea and palpitations over the last three months.
Examination reveals a temperature of 40.6ºC, pulse rate of 160 beats per minute and blood pressure of 110/70 mmHg. Her pulse is irregularly irregular. Heart sounds 1 and 2 are present with no added sounds, lung fields are clear and her abdomen is soft and nontender, with bowel sounds being present.
Blood tests are taken and reveal:
Hb 13.2 g/dL
Platelets 180 * 109/l
WBC 10.2 * 109/l
Na+ 135 mmol/l
K+ 4.2 mmol/l
Urea 7.2 mmol/l
Creatinine 132 µmol/l
Thyroid stimulating hormone (TSH) 0.03 mu/l
Free thyroxine (T4) 31 pmol/l
Total thyroxine (T4) 220 nmol/l
What is the most appropriate immediate treatment?
A 58-year-old female presents with a cosmetic concern of a lump in her neck. She reports no other symptoms and her past medical history includes hypertension and constipation. On examination, her neck lump is hard, non-tender and measures 2cm by 1 cm, moving with swallowing but not with tongue protrusion. Her blood pressure is elevated at 213/130 mmHg. After an outpatient ultrasound and fine needle aspiration, she is admitted for further investigation due to persistent hypertension. She develops a mild headache which resolves on its own. A positive urinary metanephrine collection is obtained. What investigation is likely to produce the underlying diagnosis?