A 32-year-old man comes to the endocrine clinic for follow-up. He was diagnosed with Addison’s disease a year ago and has been successfully treated with hydrocortisone. He reports feeling much better and has regained his weight and energy levels. He is planning a trip to South Africa and has already prepared by ensuring he has enough hydrocortisone and medical insurance. What precautions should he take before his travels?
A 26-year-old female presents to the clinic with a worsening of fatigue that she has been experiencing for several months. She reports constipation, cold intolerance, and dry skin. She has no significant medical history and is not taking any regular medications. During examination, her lying blood pressure is 110/75 mmHg, which drops to 95/60 mmHg upon standing.
The following are the results of her investigations:
– Hemoglobin (Hb): 110 g/l
– Sodium (Na+): 131 mmol/l
– Fasting glucose: 7.5 mmol/l
– Platelets: 425 * 109/l
– Potassium (K+): 5.1 mmol/l
– Bicarbonate: 19 mmol/l
– White blood cells (WBC): 10.1 * 109/l
– Urea: 10.5 mmol/l
– Creatinine: 110 µmol/l
What is the most likely diagnosis?
A 32-year-old female patient presents to her GP with concerns about excessive hair growth. She is also struggling to conceive and has been diagnosed with PCOS due to her ultrasound showing polycystic ovaries. Her weight is above average and she has acne. What hormone excess is responsible for her hirsutism?
What is the primary reason for hyperandrogenism in women who are in their reproductive years?
A 17-year-old boy is referred to the Endocrinology Clinic. He presents with short stature (less than the lower 3rd centile) and his weight is between the 10th and 15th centiles.
Upon examination, he has no pubic hair and pre-pubertal testes. There is no family history and he is currently well except for a three-month history of headaches. The patient undergoes appropriate investigations and imaging studies, and the result of the CT scan of the head reveals the presence of a suprasellar calcified cyst with the cyst content having the same density as the cerebral spinal fluid (CSF).
What is the most probable diagnosis?
A 55-year-old obese man presented to the emergency department with central chest pain, sweating, shortness of breath, and pallor. He was diagnosed with a STEMI and underwent primary PCI. An ECHO revealed an EF of 35% after the event. Further investigation for his coronary artery disease led to a diagnosis of type 2 diabetes. He was given iv insulin, which controlled his blood glucose temporarily.
Lab Results:
– Creatinine: 122 umol/L
– Urea: 8.2mmol/l
– Na+: 140 mmol/l
– K+: 3.6 mmol/l
– eGFR: 62 ml/min
– HbA1C: 9.4%
– HCO3: 22
– Aspartate transaminase: 52 U/L
– Alkaline phosphatase: 110 U/L
– Gamma-glutamyl transferase: 39 U/L
Which hypoglycemic agent should be avoided in the long-term treatment of his diabetes?
A 63-year-old woman presents with persistent hypertension and obesity, along with complaints of excessive pigmentation and headaches. In the 1970s, she underwent investigation for obesity, mild diabetes mellitus, and hypertension, which led to a bilateral adrenalectomy – the treatment of choice at the time. Since then, she has been on hydrocortisone and fludrocortisone treatment. On examination, she displays hyperpigmentation and striae, with a blood pressure reading of 175/100 mmHg. Visual fields appear normal. What is the probable diagnosis in this case?
A 65 year-old woman presents with persistent hypertension and obesity, along with complaints of excessive pigmentation and headaches. She has a past medical history of investigation for obesity, mild diabetes mellitus, and hypertension in the 1970s, which led to a bilateral adrenalectomy. Since then, she has been on hydrocortisone and fludrocortisone treatment. On examination, she exhibits hyperpigmentation and striae, and her blood pressure is 175/100 mmHg. Visual fields appear normal. What is the most appropriate investigation to confirm the diagnosis?
A 75-year-old woman was referred to the outpatient clinic by her GP. The GP’s note indicated that the patient had suffered a femoral neck fracture three months ago while walking. The fracture was treated with a dynamic hip screw. The patient was seeking treatment to strengthen her bones and prevent future fractures. Apart from a hysterectomy and bilateral oophorectomy at age 45 for severe menorrhagia, she had no significant medical history. Physical examination revealed no abnormalities. What is the most appropriate treatment option for this patient?
A 50-year-old man has been prescribed 500mg metformin BD for his type 2 diabetes mellitus after failing to achieve his target HBA1c of 6.5% 6 months ago. He has come for his routine check-up and reports feeling well. He confirms that he has been adhering to his metformin regimen, maintaining a healthy diet, and exercising regularly. His latest HBA1c reading is 7.3%, and all other tests are normal. What is the next best course of action to manage his diabetes?