A 25-year-old female patient comes to the clinic complaining of amenorrhoea. Upon conducting blood tests, the following results were obtained:
Prolactin 320 IU/L (<230) Oestrogen 900 pmol/L (100-400 follicular phase) LH <1 IU/L - FSH 2 IU/L – Based on these findings, what is the most probable diagnosis?
A 16-year-old girl presents to the clinic with complaints of agitation and weight gain. She is accompanied by her mother who reports that her daughter has been increasingly agitated with poor sleep over the last two months. Although her progress at school has been fine up until recently, she has become apathetic. The patient has no significant medical history. On examination, her blood pressure is 112/70 mmHg and her BMI is 20. The GP’s letter reveals the following results: TSH 3.2 mU/L (0.4-5.0), Total T4 250 nmol/L (55-144), Free T4 12.9 pmol/L (10-22), Total T3 3.2 nmol/L (0.9-2.8), Free T3 3.8 pmol/L (5-10). What is the likely diagnosis?
A 54-year-old man with type 1 diabetes presents to the hospital with a day of vomiting and diarrhea. He experienced indigestion earlier in the day, which he treated with antacids, but the burning pain in his chest and throat persisted for four hours. Despite several insulin boluses, his blood glucose continued to rise. He denies any missed doses of insulin, changes in exercise, or skipped meals. He smokes 20 cigarettes a day and manages his diabetes with a basal bolus regimen and correction doses based on carbohydrate counting.
During the examination, the patient appears sweaty with dry mucosa. His heart rate is 125/min, respiratory rate is 28/min with prolonged expiration phases, blood pressure is 110/90 mmHg, and temperature is 37ºC. The nurse measures his blood glucose, which is 27 mmol/l, and his blood ketones, which are 4 mmol/l.
Lab results show Hb 130 g/l, Na+ 133 mmol/l, Platelets 356 * 109/l, K+ 4.5 mmol/l, WBC 9.8 * 109/l, Neuts 7.5 * 109/l, Lymphs 1.0 * 109/l, Eosin 0.1 * 109/l, Urea 6.2 mmol/l, Creatinine 98 µmol/l, CRP 34 mg/l, and HbA1c 48 mmol/mol (normal range <42). The ECG shows deep T-wave inversion in V1-V4, and the chest x-ray shows no acute abnormalities. What is the most likely cause of this patient’s presentation?
A 28-year-old man is referred to the Endocrinology Clinic by his primary care physician. He has had two episodes of fainting over the past three months. There is also a history of increased thirst and urination, which has been accompanied by gradual weight loss.
On further questioning, family history reveals no useful information. You elect to admit him for a period of fasting. The morning after admission, some 14 hours without food, he complains of feeling dizzy.
Investigations reveal the following:
Glucose 2.8 mmol/l < 7 mmol/l
Insulin 2 mU/l with decreased proportion of pro-insulin
C-peptide Decreased
Cortisol 400 nmol/l
9 am: 140–500 nmol/l
Midnight: 50–300 nmol/
Which of the following diagnoses fits best with this clinical picture?
A 42-year-old woman with a lengthy history of Type 1 diabetes arrives at the Emergency Department with a sudden onset of diplopia. Despite basal bolus insulin, her diabetes is poorly controlled, and a recent HbA1c test showed a reading of 76 mmol/mol (9.1%). She has previously undergone laser therapy for diabetic retinopathy, experiences numbness in both feet, and has recovered from a left common peroneal nerve palsy. During the examination, her right eye is looking down and out, there is a ptosis on the right-hand side, and the pupil appears unaffected.
Investigations:
Hb 120 g/l
WCC 7.1 x109/l
PLT 201 x109/l
Na+ 137 mmol/l
K+ 5.0 mmol/l
Creatinine 132 micromol/l
Glucose 9.3 mmol/l
ESR 9 mm/1st hour
What is the most probable underlying cause of her cranial neuropathy?
A 59-year-old woman with poorly controlled type II diabetes presents to the Emergency Department with burning pain and weakness in her left thigh after starting insulin therapy. She is not due for follow-up in clinic for two months. On examination, she has a blood pressure of 145/90 mmHg, and neurological findings reveal weakness and wasting of the left quadriceps, loss of the left knee jerk, and slightly diminished sensation over the medial aspect of the thigh. Her HbA1c is 64 mmol/mol (8.0%), and other investigations are within normal limits. Based on these findings, what is the most likely diagnosis?
A 14-year-old girl comes to the Endocrine Clinic with her parents. They are concerned about her excessive weight gain. Apparently, she has gained a significant amount of weight in the past six months and her parents are unable to find clothes that fit her. She has no significant past medical history apart from asthma.
On examination, her blood pressure is 128/86 mmHg; pulse is 76 bpm and regular. She is 1.65 m tall and has a BMI of 32 (her parents have a BMI of 24 and 25). She has a round face, a buffalo hump, and appears to have excess hair growth. You note normal secondary sexual characteristics.
Investigations:
Haemoglobin (Hb) 138 g/l 135–175 g/l
White cell count (WCC) 6.2 × 109/l 4–11 × 109/l
Platelets (PLT) 240 × 109/l 150–400 × 109/l
Sodium (Na+) 139 mmol/l 135–145 mmol/l
Potassium (K+) 4.1 mmol/l 3.5–5.0 mmol/l
Creatinine (Cr) 80 µmol/l 50–120 µmol/l
Glucose 7.2 mmol/l (fasting) < 7 mmol/l
Cortisol 800 nmol/l (8 am) 171–536 nmol/l
Which of the following is the most likely diagnosis?
A 48-year-old woman presented to the outpatient clinic with a four-week history of diarrhea and weight loss. She had no significant medical history and was not taking any regular medications. On examination, a smooth, diffusely enlarged mass was palpable over her trachea, which moved upwards on swallowing. Her pulse was regular at 100 beats per minute, and her blood pressure was 135/60 mmHg. Her abdomen was soft and non-tender with active bowel sounds, and a fine tremor was noted.
The following investigations were conducted:
– Serum sodium: 139 mmol/L (137-144)
– Serum potassium: 4.1 mmol/L (3.5-4.9)
– Serum urea: 3.2 mmol/L (2.5-7.5)
– Serum creatinine: 89 µmol/L (60-110)
– Plasma T4: 55 nmol/L (58-174)
– Plasma free T4: 9 pmol/L (10-22)
– Plasma TSH: <0.2 mU/L (0.4-5.0)
– Plasma thyroid binding globulin: 22 mg/L (13-28)
– Radioactive iodine uptake was found to be increased.
What is the most likely diagnosis?
A 72-year-old woman who has been on long-term amiodarone therapy for paroxysmal AF presents to the clinic with complaints of increasing palpitations, weight loss, and heat intolerance over the past few months. During the examination, her blood pressure is 149/89 mmHg, pulse is 85 and regular, and she appears sweaty with a tremor. A TSH test reveals a measurement of 0.1 IU/L. What is the most effective way to differentiate between type 1 and type 2 Amiodarone-induced thyrotoxicosis (AIT)?
A 23-year-old male patient presents to his family doctor with concerns about delayed puberty. He has difficulty forming romantic relationships and feels that things always fall apart when things become physical. Upon examination, he has minimal body hair and an underdeveloped penis with small testicles. His blood pressure and body mass index are within normal limits. He also reports a loss of sense of smell. The following investigations were conducted:
Testosterone: 6 nmol/L (normal range: 9-35 nmol/L)
Follicle-stimulating hormone (FSH): 0.8 U/L (normal range: 1-25 U/L)
Luteinizing hormone (LH): 0.6 U/L (normal range: 1-70 U/L)
Thyroid-stimulating hormone (TSH): 1.1 µU/L (normal range: 0.17-3.2 µU/L)
What is the most likely diagnosis based on this clinical presentation?