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 62-year-old male presents to his doctor for a routine check-up and expresses concern about his overall health. He was diagnosed with hypertension two years ago and has since been on a diet to manage it. He quit smoking a decade ago but still drinks about 20 units of alcohol per week. He is worried about his weight and his family history of diabetes, as his father and mother both had it and suffered from stroke and heart attack respectively.
During the examination, his BMI is found to be 33.4 kg/m2, pulse is 82 beats per minute, and blood pressure is 148/92 mmHg. However, his cardiovascular, respiratory, and abdominal exams are normal except for central adiposity. His test results show normal full blood count, serum sodium, serum potassium, serum urea, and fasting plasma glucose. However, his alkaline phosphatase and serum triglycerides are high, while his aspartate transaminase and serum cholesterol are within normal range.
Given his family history and risk factors, what is the best approach to reduce the likelihood of this patient developing diabetes mellitus in the future?
A 60-year-old man is hospitalized with pneumonia and hyponatraemia, presenting a sodium level of 116 mmol/l. He received antibiotics and rapid infusions of 3% hypertonic sodium chloride, but despite initial improvement, he suffered neurological deterioration with seizures and subsequent coma the next day. What could be the reason for his decline?
A 20-year-old male has been referred to the endocrine clinic due to low libido and difficulty in forming sexual relationships. Upon examination, he is found to be tall, with a height of 6 feet 3 inches. His blood pressure is 122/82 mmHg, pulse is regular at 70 beats per minute, and his BMI is 21. He has a long arm span and sparse secondary sexual hair, with small testes measuring less than 5 ml bilaterally. The concern is his long-term risk of osteoporosis.
What would be the proposed management plan for this patient?
You assess a 75-year-old male in the endocrine clinic who has been diagnosed with hypothyroidism for the past 20 years. He also has a medical history of dyslipidemia and chronic obstructive pulmonary disease (COPD). The patient is currently taking levothyroxine 125 mcg daily, atorvastatin 20 mg daily, budesonide/formoterol inhaler 2 puffs BD, and salbutamol inhaler PRN. The latest thyroid function tests reveal:
TSH 0.4 mIU/l
FT4 29 pmol/l
Based on these results, you decide to decrease the dose of levothyroxine. What is the potential danger of over-replacement with levothyroxine?