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SEND - Endocrinology and Diabetes (Specialty Certificate Examination) Questions 46–50 (page: 11)

A 55-year-old woman presented with thirst, polyuria and polydipsia. Her symptoms had started 9 months previously following a road traffic accident. Her past medical history was normal and she was not taking any regular medication.
On examination, her blood pressure was 130/80 mmHg with no postural drop. Urine volume measured 5 L in 24 hours.

Investigations:
serum sodium131 mmol/L (137–144) serum potassium3.6 mmol/L (3.5–4.9) serum urea2.0 mmol/L (2.5–7.0)
serum corrected calcium2.40 mmol/L (2.20–2.60) fasting plasma glucose6.4 mmol/L (3.0–6.0) serum osmolality278 mosmol/kg (278–300) urinary osmolality100 mosmol/kg (100–1000)

What is the most likely diagnosis?

A 39-year-old man was admitted with severe burns.
On examination, he was noted to be persistently tachycardic. Investigations:

-serum thyroid-stimulating hormone0.2 mU/L (0.4–5.0) serum free T410.0 pmol/L (10.0–22.0)
-serum free T32.5 pmol/L (3.0–7.0)

What is the most appropriate next step in investigation of his thyroid status?

A 26-year-old woman with type 1 diabetes mellitus was seen in the antenatal diabetes clinic and was 8 weeks pregnant. The father of her child also had type 1 diabetes mellitus. They were concerned that their child might develop type 1 diabetes mellitus.
What is the likelihood of the child developing type 1 diabetes mellitus?

A 43-year-old man was in an ENT ward, having recently undergone removal of a carotid body tumour. Five years previously, he had undergone a similar procedure in another hospital. He also recalled that his brother had undergone surgery for a similar condition, and that his father, who had since died, might also have had neck surgery.
The ENT surgeons were concerned that there might be an underlying genetic diagnosis. What is the most likely diagnosis?

A 54-year-old man on the neurosurgery unit developed hyponatraemia 3 days after presenting with a significant head injury. His Glasgow coma score (GCS) had been 6 on admission.
On examination, his GCS was 12. His blood pressure was 124/84 mmHg. There was no oedema.

Investigations:
-serum sodium118 mmol/L (137–144) serum urea3.0 mmol/L (2.5–7.0) serum creatinine72 µmol/L (60–110)
-random serum cortisol (08.00 h on day of review)480 nmol/L serum thyroid-stimulating hormone1.2 mU/L (0.4–5.0) random urinary sodium60 mmol/L

What is the most appropriate interpretation of these data?