A 45-year-old man visits his GP for a medication review for his hypertension. During the examination, the GP observes that the patient has prominent supraorbital ridges, large hands and feet, and acanthosis nigricans of the axillae. The GP also discovers enlargement of the thyroid gland and hepatomegaly. Besides hypertension, what other condition is frequently linked to acromegaly?
A 45-year-old woman visits her GP for a check-up on her blood pressure, which has been difficult to manage despite lifestyle changes and taking a combination of ramipril and felodipine. On examination, there are no clinical indications to aid in diagnosis. The GP conducts a urinalysis, which comes back normal, and orders some blood tests. The results show:
Investigation Result Normal value
Sodium (Na+) 175 mmol/l 135–145 mmol/l
Potassium (K+) 3.1 mmol/l 3.5–5.0 mmol/l
Urea 4.1 mmol/l 2.5–6.5 mmol/l
Creatinine 75 μmol/l 50–120 μmol/l
eGFR >60 ml/min/1.73m2 >60 ml/min/1.73m2
Based on this presentation, what is the most probable secondary cause of hypertension?
A 57-year-old woman presents to the diabetic clinic with concerns about her worsening blood sugar control. She was diagnosed with diabetes three years ago and has had hypertension for five years. Her current medications include atenolol, amlodipine, and metformin.
During the examination, her weight is recorded as 98.5 kg, which is 5 kg more than her previous weight after losing 4 kg. Her BMI is 34.6, and her blood pressure is 156/94 mmHg. There are no signs of neuropathy or retinopathy. Her fasting glucose is 8.2 mmol/L (148 mg/dL), and her HbA1c has increased by 1% to 77 mmol/mol (20-42) since her last visit six months ago.
The patient expresses difficulty adhering to her diet and requests assistance with her weight. What would be your recommendation for treating her obesity?
A 45-year-old male presents with symptoms of polyuria and polydipsia. He is a non-smoker and drinks approximately 12 units of alcohol per week. He works as a taxi driver.
During examination, his BMI is found to be 33.4 kg/m2, and his blood pressure is 132/82 mmHg. All other aspects of his cardiovascular examination are normal.
Further investigations confirm a diagnosis of diabetes mellitus, with the following results:
– Fasting blood glucose: 12.1 mmol/L (3.0-6.0)
– HbA1c: 75 mmol/mol (20-42)
– Total cholesterol: 5.8 mmol/L (<5.2)
What would be the most appropriate initial treatment for this patient?
A 54-year-old truck driver weighing 104 kg visits your clinic. The practice nurse conducted a fasting glucose test, which showed a reading of 7.9 mmol/L. The test was repeated, and the result was 8.6 mmol/L. Despite receiving diet and lifestyle advice, the patient’s HbA1c level is 69 mmol/mol (8.5%) after three months. What is the next course of action?
You review a 56-year-old man with a history of type II diabetes. He was diagnosed 1 year ago and is currently managed with diet and exercise, and additional medication includes ramipril 10 mg po daily, atorvastatin 10 mg and aspirin 75 mg/day. On examination, his blood pressure is measured at 129/75 mmHg. Low-density lipoprotein (LDL) cholesterol is 2.1, HbA1c 62 mmol/mol and creatinine 110 μmol/l.
Which of the following is the most appropriate next treatment step in this case?
A floppy 1-month-old infant presented with vomiting, weight loss and circulatory collapse. Blood tests demonstrated hyponatraemia and hyperkalaemia. Further tests confirmed metabolic acidosis and hypoglycaemia. The paediatrician noticed that the penis was enlarged and the scrotum pigmented. The child was treated with both a glucocorticoid and a mineralocorticoid.
What is the most likely underlying diagnosis?
A 28-year-old patient is admitted with vomiting and abdominal pain. She was noted to have marked buccal pigmentation.
Examination reveals dehydration, pulse 100 bpm, blood pressure (BP) 90/60 mmHg. Initial blood tests show: glucose 2.9 mmol/l, sodium (Na+) 126 mmol/l, potassium (K+) 4.9 mmol/l, urea 8.2 mmol/l, creatinine 117 µmol/l.
Which of the following is the most likely diagnosis?
A 39-year-old man comes to his GP complaining of sudden headaches accompanied by sweating and palpitations. Upon examination, the patient appears anxious and has a pale complexion. His blood pressure measures 240/200 mmHg, and a 24-hour urine collection shows increased levels of catecholamines. What is the probable cause of this man’s hypertension?
A 42-year-old male presents to the Emergency department with complaints of headaches and tiredness during exercise for the past three weeks. He is a smoker of five cigarettes per day and drinks approximately 20 units of alcohol each week. There is no significant family history. On examination, his pulse is 78 beats per minute, and his blood pressure is 182/102 mmHg. However, there are no abnormalities on examination of heart, chest, or abdomen. The investigations reveal a sodium level of 144 mmol/L (137-144), haemoglobin level of 155 g/L (130-180), potassium level of 2.8 mmol/L (3.5-4.9), white cell count of 8.2 ×109/L (4-11), urea level of 5.0 mmol/L (2.5-7.5), platelet count of 188 ×109/L (150-400), creatinine level of 90 µmol/L (60-110), and glucose level of 5.6 mmol/L (3.0-6.0). The ECG shows tall R waves in leads V5-6 and deep S waves in leads V1-2. The chest x-ray is reported as normal. What possible diagnosis would you consider for this patient?