A 57-year-old woman visits the endocrinology clinic after a CT scan revealed a 3mm mass in her thyroid. The scan was originally done to assess her neck stability as she was scheduled for general anesthesia and intubation for a coronary arterial bypass graft. She has a medical history of type 2 diabetes mellitus, high cholesterol, and hypertension, but no symptoms of thyroid dysfunction. What is the best course of action?
A 22-year-old female presents with a two-month history of fatigue, muscle pain, and unintentional weight loss. On examination, there are no significant findings. Her vital signs are within normal limits, with a heart rate of 72/min, respiratory rate of 14/min, oxygen saturation of 99% on room air, and blood pressure of 110/80 mmHg. She has no fever.
Routine blood tests are ordered, and the results are as follows:
– Hemoglobin: 150 g/l
– Platelets: 200 * 109/l
– White blood cells: 12.0 * 109/l
– Neutrophils: 8.0 * 109/l
– Lymphocytes: 4.0 * 109/l
– Sodium: 128 mmol/l
– Potassium: 2.9 mmol/l
– Urea: 7.0 mmol/l
– Creatinine: 85 µmol/l
– C-reactive protein: 11 mg/l
What is the most appropriate next step in the investigation for this patient?
A 14-year-old male presents to the clinic with complaints of steatorrhoea and poor growth. He has a family history of abetalipoproteinemia. The patient is not taking any regular medications. Upon examination, the patient exhibits ataxia and reduced visual acuity (6/12 in the right eye and 6/15 in the left eye).
The following investigations were conducted:
– Hb: 110 g/l
– Platelets: 380 * 109/l
– WBC: 10.1 * 109/l
– Neuts: 6.8 * 109/l
– Blood film: Acanthocytosis
– Na+: 136 mmol/l
– K+: 3.9 mmol/l
– Urea: 6.6 mmol/l
– Creatinine: 48 µmol/l
What management plan would you suggest for this patient?
These thyroid function tests were obtained from a 60-year-old female who presents with fatigue. Past history includes hypertension and osteoporosis, for which she takes medication.
Free T4 23.5 pmol/L (10-22)
Free T3 2.8 pmol/L (5-10)
TSH 7.2 mU/L (0.4-5)
What is the most probable reason for these findings?
You are seeing a 37-year-old woman with type 1 diabetes mellitus in your clinic. She is currently managing her diabetes with a basal-bolus regimen and takes citalopram 20mg od for depression. She was diagnosed with type 1 diabetes at the age of 13. Her recent blood work shows:
– Na+ 142 mmol/l
– K+ 3.9 mmol/l
– Urea 4.9 mmol/l
– Creatinine 79 µmol/l
– Total cholesterol 4.4 mmol/l
– HDL cholesterol 1.2 mmol/l
– LDL cholesterol 1.8 mmol/l
– Triglyceride 1.3 mmol/l
– Urine dip: No protein or blood
What would be the most appropriate approach to managing her lipid levels?
A 55-year-old woman presents for follow-up in the general medical clinic. She was diagnosed with type 2 diabetes mellitus eight months ago after experiencing fatigue and polyuria. She has a history of hypothyroidism but no other medical conditions. Initially, she was prescribed metformin 500mg twice daily, but she had difficulty managing due to gastrointestinal side effects, including diarrhea. What would be the best course of action?
A 38-year-old man presents to the Endocrine Clinic for a 6-month follow-up after surgery for a growth hormone secreting pituitary adenoma. He initially went to his primary care physician with changes in his facial appearance, soft tissue swelling affecting his hands and feet, and impaired glucose tolerance. His glucose metabolism has returned to normal.
During examination, his blood pressure is 150/80 mmHg, pulse is 72 bpm and regular, and BMI is 24 kg/m2.
Lab results show:
– Haemoglobin (Hb): 135 g/l (normal range: 115-155 g/l)
– White cell count (WCC): 6.5 × 109/l (normal range: 4-11 × 109/l)
– Platelets (PLT): 200 × 109/l (normal range: 150-400 × 109/l)
– Sodium (Na+): 138 mmol/l (normal range: 135-145 mmol/l)
– Potassium (K+): 4.2 mmol/l (normal range: 3.5-5.0 mmol/l)
– Creatinine (Cr): 85 µmol/l (normal range: 50-120 µmol/l)
– Glucose: 5.3 mmol/l (normal range: 3.9-7.1 mmol/l)
– Insulin-like growth factor (IGF-1): Just above the upper limit of normal
What is the most likely long-term consequence of acromegaly in this patient?
A 25-year-old woman presents to the endocrine clinic for follow-up. She has a medical history of hypertension that is controlled with ramipril and indapamide. During her birth, the midwives noticed clitoromegaly, and she was later diagnosed with 11-beta hydroxylase deficiency. What lab result is expected to be significantly elevated?
A 32-year-old woman is seen for a follow-up appointment 6 months after giving birth. She was diagnosed with gestational diabetes during her pregnancy, but her blood sugar levels have not improved since delivery and she has now been diagnosed with type 2 diabetes mellitus. Despite being only slightly overweight with a body mass index of 27.1 kg/m², you are concerned about the possibility of missing a diagnosis of maturity onset diabetes of the young (MODY) or type 1 diabetes. What clinical feature would be most indicative of MODY?
A 23-year-old female with a history of type 1 diabetes mellitus presents with a six-month history of weight loss, anorexia, and fatigue. Her diabetes was previously well controlled with insulin, but she has noticed a decrease in insulin requirement and has experienced hypoglycemic attacks. She has also lost approximately 7 Kg in weight and has been amenorrheic for the last three months. On examination, she is thin with a pulse rate of 70 beats per minute and a blood pressure of 110/70 mmHg with a postural drop. Which investigation is most appropriate for this patient?