A 28-year-old woman has been referred to the Endocrinology clinic after discovering she is pregnant. She was diagnosed with hypothyroidism two years ago and is currently stable on a dose of levothyroxine 75 mcg once daily. She has also been taking folic acid 400 mcg once daily for the past 6 months. Her last blood test taken 6 months ago showed a TSH level of 1.4 mU/l.
You decide to order a repeat TSH and free T4 measurement. What is the most appropriate next step?
A 36-year-old patient arrives at the emergency department via ambulance. Despite recently moving locally, she has not yet registered with a GP and has experienced a lapse in her supply of carbimazole for hyperthyroidism, which was diagnosed three months ago. She is currently in a very unwell state, reporting palpitations. Upon examination, she displays a raised JVP, bilateral crepitations upon auscultation, severe peripheral edema, and has become extremely breathless. Her temperature is 40.1 degrees C. Oxygen is administered. An ECG reveals a heart rate of 170 bpm in AF, while a chest X-ray shows pulmonary edema. What is the most appropriate immediate course of action?
A 50-year-old man visits the endocrine clinic for assessment. He has experienced a weight gain of 3 stones in the last 6 months, and his general practitioner is concerned about the possibility of Cushing’s syndrome. An initial 24-hour urinary free cortisol test has been conducted, which shows elevated levels. The patient has hypertension, with a blood pressure reading of 155/90 mmHg, and his pulse is regular at 75 beats per minute. He has a body mass index of 35 kg/m² and noticeable abdominal striae. Which of the following findings would be most indicative of an adrenal adenoma that produces cortisol?
A 26-year-old nurse presents after collapsing on a night shift. His blood glucose is measured at being 1.4 mmol/l. His blood pressure at the time was noted to be 115/82 mmHg. He has no palpitations and had not bitten his tongue or become incontinent during the episodes. He was shaken afterwards, although did not have memory loss and stated he had not tripped over anything. He also said he has had five of these episodes over the last two weeks.
Blood tests are sent off and unremarkable except for a low-normal C-peptide level and markedly raised insulin level.
What is the most likely diagnosis for the multiple episodes of collapse in this 26-year-old nurse?
A 72-year-old man with advanced prostate cancer and bone metastases is admitted to the hospital, complaining of generalised abdominal pain and presenting with some confusion. Various blood tests are conducted, including the following:
Calcium 3.2 mmol/L (2.1-2.6)
Despite aggressive intravenous fluid rehydration (4-6 litres per day) and the administration of Pamidronic acid, the treatment proves to be ineffective. A repeat blood test shows a similar result:
Calcium 3.18 mmol/L (2.1-2.6)
What would be the most reasonable next step to take?
A 67-year-old man with a history of bladder cancer, hypertension, and chronic kidney disease presents to his GP with symptoms of polyuria and polydipsia. His current medications include amlodipine, furosemide, atenolol, and ramipril. Upon examination, there are no notable findings. Laboratory results reveal elevated levels of urea and creatinine, as well as a decreased eGFR. The patient’s HbA1c is also elevated. What medication would be the most appropriate to initiate?
A 75-year-old woman presents to the chronic kidney disease clinic with a history of hypertension. She is currently taking amlodipine 5mg od and ramipril 10mg od. Her recent laboratory results show:
Blood pressure today is 128/74 mmHg.
Recent 12 months ago
Na+ 140 mmol/l 141 mmol/l
K+ 4.5 mmol/l 4.3 mmol/l
Urea 11.2 mmol/l 10.5 mmol/l
Creatinine 124 µmol/l 114 µmol/l
eGFR 39 ml/min 43 ml/min
What would be the most appropriate course of action for her management?
A 50-year-old patient visits the endocrinology clinic due to a small thyroid nodule that was discovered incidentally. The patient reports a painless and non-tender 7mm nodule with no associated throat or systemic symptoms. The patient has a medical history of fibroids and post-partum depression but takes no regular medications. An ultrasound has been performed, and no malignant features were detected. What is the best course of action?
A 67-year-old man has been admitted with hypercalcaemia due to metastatic prostate cancer. CT scans have confirmed multiple bony, sclerotic metastases in the lumbar spine and pelvis. IV fluids have been administered since admission, and the patient has received IV pamidronate 60 mg three days ago and IV denosumab 120 mg yesterday. The adjusted calcium levels have been monitored and are as follows:
Day 1: 3.32 mmol/L
Day 2: 3.26 mmol/L
Day 3: 3.24 mmol/L
Today: 3.16 mmol/L (normal range: 2.1-2.6)
The patient’s renal function today is as follows:
Na+: 126 mmol/L (normal range: 135-145)
K+: 3.7 mmol/L (normal range: 3.5-5.0)
Bicarbonate: 23 mmol/L (normal range: 22-29)
Urea: 8.9 mmol/L (normal range: 2.0-7.0)
Creatinine: 132 µmol/L (normal range: 55-120)
What is the next appropriate step in managing this patient’s condition?
A 63-year-old man presents with breathing difficulty seven hours after undergoing thyroidectomy for hyperthyroidism. He reports feeling like his neck is tighter and the breathing difficulty has been worsening over the past hour. The patient has a medical history of COPD, angina, and ischemic heart disease. He takes aspirin, ramipril, Symbicort, bisoprolol, and atorvastatin, but stopped taking aspirin a week before surgery. On examination, his chest is clear, heart sounds are normal, and there is a small amount of strike-through bleeding from the neck wound. The patient’s heart rate is 90 bpm, blood pressure is 156/82 mmHg, and oxygen saturation is 89% on room air. His calves are soft and non-tender. What is the best course of action?