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SEND - Endocrinology and Diabetes (Specialty Certificate Examination) Questions 66–70 (page: 15)

A 61-year-old woman was found incidentally to have a raised serum calcium concentration. She was otherwise well. Her father had undergone a neck operation many years previously.

Investigations:
serum corrected calcium2.78 mmol/L (2.20–2.60) plasma parathyroid hormone10.8 pmol/L (0.9–5.4)
Her general practitioner thought she had primary hyperparathyroidism.

Which further finding is most likely to cast doubt upon this diagnosis?

A 33-year-old woman presented with tiredness, palpitations, weight loss and emotional lability 9 weeks after the birth of her third child.
On examination, she had a sinus tachycardia, a fine tremor, slight lid retraction and a mild diffuse non-tender goitre.

Investigations:
-serum thyroid-stimulating hormone<0.01 mU/L (0.4–5.0) serum free T434.3 pmol/L (10.0–22.0)
-technetium-99m scan of thyroid (20-min uptake)<1% (0.4–3.0)

What is the most appropriate treatment?

A 25-year-old woman with type 1 diabetes mellitus presented with light-headedness, nausea, thirst and vomiting of 3 days’ duration. She was fully conscious.
On examination, her pulse was 104 beats per minute and her blood pressure was 104/64 mmHg. Urinalysis showed glucose 2+, ketones 3+.

Investigations:
serum sodium150 mmol/L (137–144) serum potassium5.5 mmol/L (3.5–4.9) serum chloride105 mmol/L (95–107) serum urea5.0 mmol/L (2.5–7.0) serum creatinine90 µmol/L (60–110) random plasma glucose20.0 mmol/L arterial blood gases, breathing air:
-PO212.4 kPa (11.3–12.6)
-PCO23.4 kPa (4.7–6.0)
-pH7.15 (7.35–7.45)
-H+70 nmol/L (35–45)
-bicarbonate6 mmol/L (21–29)

What intravenous fluid should be given over the first 30 minutes?

A 36-year-old woman was seen in the clinic with a recurrence of hyperthyroidism after a 2-year remission. She had been treated with carbimazole for 18 months following her original presentation. She was moderately symptomatic and was keen to be treated in the same way again. She was planning a pregnancy.

Investigations:
-serum prolactin240 mU/L (<360)
-serum thyroid-stimulating hormone<0.1 mU/L (0.4–5.0) serum free T428.0 pmol/L (10.0–22.0)
-anti-thyroid-stimulating hormone receptor antibodies44 U/L (<7)

What is the most appropriate next step in management?

A 45-year-old woman was found to be hypertensive by her general practitioner. She was otherwise well and was not taking any medication. However, she regularly ate health food containing liquorice. There was no family history of significant illness.

On examination, her blood pressure was 170/110 mmHg. Investigations:
-serum sodium140 mmol/L (137–144) serum potassium3.8 mmol/L (3.5–4.9) serum creatinine70 µmol/L (60–110)
-plasma renin activity (after 30 min supine)0.5 pmol/mL/h (1.1–2.7) plasma aldosterone (after 30 min supine)450 pmol/L (135–400)

During the investigations, her blood pressure was controlled with doxazosin. What is the most likely diagnosis?