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SEND - Endocrinology and Diabetes (Specialty Certificate Examination) Questions 51–55 (page: 12)

A 34-year-old man was referred to the diabetes outpatient clinic with impaired glucose tolerance. He had a family history of diabetes mellitus and had a body mass index of 34.6 kg/m2 (18–25).
On examination, his blood pressure was 140/82 mmHg. He wished to delay the onset of frank diabetes mellitus. What is the most effective way of achieving this outcome?

A 32-year-old man presented to the fertility clinic with his partner. The couple had been together for 4 years and had been trying to conceive for the past 3 years. His partner had children from a previous marriage.
On examination, he was healthy, thin and tall but had bilateral gynaecomastia. His testes felt firm and testicular volumes were 5–6 mL. He had normal pubic and axillary hair.

Investigations:
-serum testosterone10.0 nmol/L (9.0–35.0)
-plasma follicle-stimulating hormone45.0 U/L (1.0–7.0) plasma luteinising hormone32.0 U/L (1.0–10.0) chromosomal studiesmosaic pattern of 47 XXY/46 XY semen analysisazoospermia
-testicular biopsyno viable spermatozoa

What intervention is most likely to lead to conception?

A 70-year-old man was admitted after the gradual development of confusion. He had no significant medical history.

Examination was otherwise normal. Investigations:
serum sodium110 mmol/L (137–144) serum potassium3.8 mmol/L (3.5–4.9) serum creatinine50 µmol/L (60–110)
He was treated with several litres of sodium chloride 0.9% over the subsequent few days, resulting in a rapid restoration of serum sodium to the normal range. This coincided with the development of limb weakness and spasticity that became permanent.

The movement of what substance(s) between the intracellular fluid compartment (ICF) and extracellular fluid compartment (ECF) explains the changes in this patient?

An 85-year-old woman was referred with a lump in her neck. She had no symptoms of thyroid disease.
On examination, she had a 2 ? 3-cm firm mass at the lower pole in the right thyroid lobe. Her resting pulse was 90 beats per minute and regular.

Investigations:
-serum thyroid-stimulating hormone3.5 mU/L (0.4–5.0) serum free T415.0 pmol/L (10.0–22.0)
-serum free T36.2 pmol/L (3.0–7.0)
-anti-thyroid peroxidase antibodies28 IU/mL (<50) ultrasound scan of thyroidmixed cystic/solid mass with scattered microcalcifications
-fine-needle aspiration biopsyThy 3a

What is the most appropriate next step in her management?

An 18-year-old man, whose ambition was to become a member of the elite armed forces, presented with gynaecomastia. His weekly alcohol consumption was 35 units.
On examination, he had normal secondary sexual characteristics, a well-developed, muscular physique and modest, slightly tender bilateral gynaecomastia. Testes were 10 mL with soft texture.

Investigations:
-haemoglobin160 g/L (130–180)
-MCV96 fL (80–96)
-serum dehydroepiandrosterone sulphate4 µmol/L (2–10) serum oestradiol180 pmol/L (<180)
-serum testosterone (09.00 h)6.0 nmol/L (9.0–35.0) plasma follicle-stimulating hormone1.0 U/L (1.0–7.0) plasma luteinising hormone0.7 U/L (1.0–10.0)
-serum prolactin420 mU/L (<360)

What is the most likely diagnosis?