serum growth hormone (day curve average)3.2 ?

A 64-year-old woman presented with features of acromegaly. An MR scan showed a pituitary tumour with cavernous sinus extension. She underwent trans-sphenoidal surgery and histology of the pituitary tissue showed numerous cells immunostaining for growth hormone. Investigations (6 months postoperatively): MR scan of pituitaryenlarged sella, residual tumour in right cavernous sinus serum growth hormone...

What is the most appropriate approach to annual screening for phaeochromocytoma?

A 32-year-old man presented with medullary thyroid cancer, treated by total thyroidectomy. He had a past history of primary hyperparathyroidism, treated by selective parathyroidectomy. Postoperatively, plasma calcitonin was undetectable and serum calcium was in the normal range. Investigations: RET genotypeheterozygote codon 634 C>T mutation What is the most appropriate approach to annual screening for...

What is the best estimate for the proportion of vertebral fractures that present clinically with back pain, as seen in this patient?

A 77-year-old woman presented with acute severe pain in the mid-thoracic spine after lifting a heavy bag of shopping. She had reported losing 6 cm in height over the preceding 5 years. On examination, she was of slight build and experienced difficulty rising from a chair. There was tenderness in the region of T9/10....

What substance is most likely to cause assay interference in the measurement of urinary metanephrines?

A 23-year-old barmaid presented with headache, sweating and collapse. She had a past medical history of tension headache and unexplained abdominal pain. Her regular medication included amitriptyline 25 mg at night and paracetamol 1 g as required. She was a smoker and regularly drank alcohol. On examination, her pulse was 120 beats per minute...

According to the Joint British Diabetes Societies Guidelines (2012), what is the most appropriate next hypoglycaemic agent?

A 72-year-old man with a dense residual hemiparesis and unsafe swallow was fed via a percutaneous gastrostomy for 20 hours each day. He had type 2 diabetes mellitus that had been well controlled with metformin. His glucose levels were uncontrolled on metformin powder at maximum dose. According to the Joint British Diabetes Societies Guidelines...