A 59-year-old man with a history of type 2 diabetes mellitus and chronic heart failure is seen in the diabetes clinic. His current medications include metformin, gliclazide, ramipril, bisoprolol, furosemide, and simvastatin. His annual blood work shows normal electrolyte levels, kidney function, and cholesterol levels, but his HbA1c is 7.7%. His blood pressure is 124/78 mmHg and his BMI is 29 kg/m². What is the most appropriate course of action regarding his anti-diabetic medication?
A 39-year-old woman presents to the Endocrine Clinic with a complaint of excessive sweating and occasional fever for the past six months. She recently went on a trip to Thailand but had to cut it short due to the unbearable heat. She has also noticed a gradual weight loss over the past year, despite having a good appetite.
Upon examination, she is tachycardic but afebrile. Her palms are sweaty, and there is no palpable goitre or cervical lymphadenopathy. Routine FBC, U&E, and LFT are within normal limits.
What is the most probable diagnosis?
A 25-year-old woman has been experiencing hirsutism for the past six years, with coarse dark hair appearing under her chin. As a nurse, this has been causing her significant distress. She has attempted to manage the symptoms with shaving and depilatory creams, but has not found a lasting solution. Her menstrual cycle is irregular, with oligomenorrhoea, and she began menstruating at the age of 13. She has not yet become pregnant and currently uses a contraceptive coil. At night, she takes 5 mg of diazepam.
During examination, her BMI was found to be 24. She has coarse, dark hair on her chin, lower back, and inner thighs. There are no other clinical features to suggest Cushing’s, and she does not have galactorrhoea.
Investigations conducted during the follicular phase revealed the following results:
– Serum androstenedione: 9.8 nmol/L (0.6-8.8)
– Serum dehydroepiandrosterone sulphate: 11.2 µmol/L (2-10)
– Serum 17-hydroxyprogesterone: 18.6 nmol/L (1-10)
– Serum oestradiol: 380 pmol/L (200-400)
– Serum testosterone: 2.6 nmol/L (0.5-3)
– Plasma luteinising hormone: 3.3 U/L (2.5-10)
– Plasma follicle-stimulating hormone: 3.6 U/L (2.5-10)
What is the most appropriate next step in investigating this patient’s condition?
A 65-year-old male was prescribed thyroxine 150 micrograms daily for hypothyroidism. He was clinically hypothyroid and no goitre was present.
At a follow-up clinic, the following results were obtained:
– Serum total T4: 68 nmol/L (55-145)
– Serum total T3: 0.5 nmol/L (0.9-2.5)
– Serum TSH: 70 mU/L (0.4-5)
What would be the next step in his management?
A 55-year-old woman with a history of Grave’s disease is seen on the medical floor 24 hours after parathyroidectomy. She is experiencing episodes of carpopedal spasm and tingling sensations around her mouth and hands. Upon examination, her blood pressure is 120/80 mmHg, and her pulse is 90 beats per minute. Her serum calcium level is measured at 1.9 mmol/l.
What is the most suitable course of action?
You assess a 63-year-old patient with type 2 diabetes who is currently on metformin 2 g per day, gliclazide 160 mg per day, and ramipril for renoprotection. The patient’s recent HbA1c was 68.31 mmol/mol (8.4%) and blood pressure was 140/75 mmHg. Upon reviewing the patient’s eye photograph, you observe dot-and-blot haemorrhages, cotton wool spots, and micro-aneurysms that are not in close proximity to the macula. What is the most effective treatment option to decrease the likelihood of further deterioration of the patient’s diabetic retinopathy in the long term, given these findings?
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?