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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...
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...
What test is most likely to aid diagnosis?
A 16-year-old girl presented with primary amenorrhoea. In early childhood she had undergone an inguinal herniorrhaphy. She had no other medical history of note. There was a family history of infertility affecting a maternal aunt. On examination, she had adult breast development but no pubic or axillary hair. Examination was...
Which feature in his clinical presentation most strongly suggests a diagnosis other than constitutional delay?
A 16-year-old boy was referred with concern about delayed puberty. His stature had been short as a child. He reported an increase in height at the age of 13, and had begun to develop pubic hair at the age of 14. He reported no further growth or development in the...
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...
What variable is it most important to monitor?
A 37-year-old man, who had previously undergone female-to-male gender reassignment surgery, attended the endocrine clinic for annual review. He had no complaints and was happy with the results of his treatment. His medication consisted of testosterone undecanoate 1 g intramuscularly every 3 months. What variable is it most important to...
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...
What is the most appropriate oral treatment?
A 55-year-old man presented with a 3-year history of increasing pain in the right hip. He had been otherwise well and was taking no medication. He was reluctant to consider any intravenous treatment as he had a phobia of needles. Investigations: X-ray of hipssclerotic bone in right pubis and ischium...
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...
What is the most appropriate first-line intervention?
A 29-year-old woman presented with primary infertility, having had unprotected sexual intercourse for 15 months. Menarche had occurred at the age of 13.5 years. Her menstrual cycle was irregular, occurring every 20C60 days. There was no history of galactorrhoea. She denied abnormal hair growth. On examination, her body mass index...
