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How do glucocorticoids reduce serum calcium in sarcoidosis?
A 46-year-old Afro-Caribbean man with sarcoidosis was found to have hypercalcaemia and was treated with prednisolone 20 mg/day. Within 3 weeks his serum calcium had fallen to within the reference range. How do glucocorticoids reduce serum calcium in sarcoidosis?A . direct calcium shift into cellsB . increase intravascular fluid volumeC...
What is the most likely diagnosis?
A 26-year-old woman was referred by her general practitioner for the management of subfertility. Her menarche had occurred at the age of 14 and she had experienced oligomenorrhoea since the age of 16. She also complained of gradually worsening hirsutism since puberty. Clinical examination showed central obesity, a body mass...
What is the most likely diagnosis?
A 56-year-old man was referred urgently by an ophthalmologist after presenting with a 6-month history of deteriorating vision. The patient had a 40 pack-year smoking history. Before his vision problem, he had never visited his general practitioner. Investigations: serum cortisol (09.00 h)389 nmol/L (200C700) serum testosterone8.6 nmol/L (9.0C35.0) plasma follicle-stimulating...
What is the most appropriate management?
A 49-year-old woman presented with a slowly enlarging lump in her neck. On examination, there was a 3.5-cm firm nodule in the left lobe of the thyroid gland, with no associated lymphadenopathy. Investigations: serum thyroid-stimulating hormone<0.05 mU/L (0.4C5.0) serum free T426.0 pmol/L (10.0C22.0) serum free T38.6 pmol/L (3.0C7.0) An ultrasound...
What is the most appropriate advice to give to the surgical team about perioperative management?
A 58-year-old man was referred to the endocrine clinic after a CT scan of abdomen had shown a 4.5-cm left adrenal mass, with a Hounsfield unit measurement of 11 (consistent with high lipid content). He had a 10-year history of type 2 diabetes mellitus and was taking metformin. He was...
What is the most likely cause of the cardiovascular deterioration following administration of propranolol?
A 41-year-old man presented to his general practitioner with symptoms of palpitations, sweating and anxiety. His blood pressure was 160/102 mmHg. He was advised to take propranolol 40 mg twice daily but was admitted to hospital later that week with an episode of pulmonary oedema. On examination at the time...
Which drug is most likely to be responsible for his diabetes of new onset?
A 55-year-old man with mild polyuria and tiredness was seen on a renal ward. He had had a living-related kidney transplant 6 months previously. He had good graft function while being treated with prednisolone 5 mg daily, mycophenolate mofetil 1 g twice daily and tacrolimus 3 mg twice daily. He...
What is the most likely diagnosis?
A 19-year-old man was seen in the diabetes clinic. He had lost 2 kg in weight since the diagnosis of diabetes mellitus 18 months previously. At presentation, his body mass index was 33 kg/m2 (18C25), his random plasma glucose was 18.0 mmol/L and his haemoglobin A1c was 56 mmol/mol (20C42)....
What complication is more likely to worsen in a patient taking a thiazolidinedione?
A 76-year-old woman with type 2 diabetes mellitus was reviewed. Treatment with thiazolidinedione was being considered, but she was worried about the effect this medication might have on the incidence of complications. She had known background retinopathy. What complication is more likely to worsen in a patient taking a thiazolidinedione?A...
What is the most important diagnosis to consider?
A 20-year-old man presented with a 6-month history of lethargy and weakness. His brother had been found to have adrenal failure at the age of 18. He had two sisters who were well and there was no other family history of endocrine autoimmune disease. On examination, his blood pressure was...
