Free SEND Exam Braindumps
SEND - Endocrinology and Diabetes (Specialty Certificate Examination) Questions 41–45 (page: 10)

A 33-year-old man was referred to the diabetes clinic with an 8-month history of weight loss and polydipsia. Two months previously his general practitioner had found a high fasting plasma glucose concentration of 17.5 mmol/L (3.0–6.0) and a haemoglobin A1c of 116 mmol/mol (20–42). The patient was taking metformin 1 g twice daily. He reported in the diabetes clinic that his home capillary blood glucose concentrations persisted to be high, ranging between 15–24 mmol/L.
On examination, his body mass index was 23 kg/m2 (18–25).
His blood tests were repeated in the diabetes clinic and he was treated with a basal bolus insulin regimen. Urinalysis was negative for ketones.

Investigations (in diabetes clinic): haemoglobin A1c110 mmol/mol (20–42) serum C-peptide200 pmol/L (180–360) anti-glutamic acid decarboxylase (GAD) antibodies69 IU/mL (<10)
anti-IA2 antibodies negative

What is the most likely diagnosis?

A 28-year-old man presented to his optician with a 6-month history of gradually deteriorating vision. He was found to have a visual field defect and was referred urgently to an ophthalmologist who confirmed the finding, and arranged the following investigations.
Investigations (at 09.00 h):

-serum cortisol300 nmol/L (200–700) serum testosterone6.5 nmol/L (9.0–35.0)
-plasma follicle-stimulating hormone1.2 U/L (1.0–7.0) plasma luteinising hormone1.3 U/L (1.0–10.0)
-serum thyroid-stimulating hormone2.4 mU/L (0.4–5.0) serum free T411.1 pmol/L (10.0–22.0)

What is the most important next investigation?

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 also taking atenolol for hypertension.
On examination at the clinic, his blood pressure was 162/94 mmHg. He was centrally obese with a body mass index of 27 kg/m2 (18–25).

Investigations:
-serum potassium3.9 mmol/L (3.5–4.9)
-plasma renin activity (after 30 min upright)1.0 pmol/mL/h (3.0–4.3) plasma aldosterone (after 4 h upright)680 pmol/L (330–830)
-overnight dexamethasone suppression test (after 1 mg dexamethasone):
-serum cortisol164 nmol/L (<50)
-24-h urinary free cortisol132 nmol (55–250)
-24-h urinary catecholamines (adrenaline and noradrenaline)normal
-As the lesion was >4 cm in diameter, laparoscopic adrenalectomy was recommended.

What is the most appropriate advice to give to the surgical team about perioperative management?

A 28-year-old woman presented to the emergency department with a 3-day history of abdominal pain. Her past medical history included intermenstrual bleeding, and she was undergoing 6-monthly renal ultrasound surveillance for a cystic lesion.

Investigations:
-serum creatinine84 µmol/L (60–110)
-serum corrected calcium3.20 mmol/L (2.20–2.60)
-serum phosphate0.7 mmol/L (0.8–1.4)
-plasma parathyroid hormone19.5 pmol/L (0.9–5.4)

What is the most likely condition underlying the clinical presentation?

A 45-year-old woman attended for annual follow-up for long-standing hypoparathyroidism (a complication of thyroid surgery 5 years previously). She was asymptomatic. She was taking alfacalcidol 1 microgram daily.

Examination was unremarkable. Investigations:
-serum creatinine105 µmol/L (60–110)
-serum corrected calcium2.45 mmol/L (2.20–2.60) 24-h urinary calcium9.8 mmol (2.5–7.5)

What is the most appropriate next step in management?