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SEND - Endocrinology and Diabetes (Specialty Certificate Examination) Questions 86–90 (page: 19)

A 19-year-old man presented with late development of his pubic and axillary hair. He was otherwise well and was not taking any medication. His serum testosterone concentration had been normal on two previous occasions.
On examination, he now had post-pubertal secondary sexual characteristics. He had 15–20 mL testes.

Investigations:
-serum testosterone27.0 nmol/L (9.0–35.0)
-serum sex hormone binding globulin28 nmol/L (10–62) serum follicle-stimulating hormone2.0 U/L (1.0–7.0) serum luteinising hormone2.9 U/L (1.0–10.0)

What is the chief product of the Sertoli cell?

A 36-year-old woman was referred to the endocrine clinic with abnormal thyroid function tests. She gave a 3- year history of increased sweating and anxiety following an assault and, initially, her symptoms had been attributed to post-traumatic stress disorder.

Investigations:
-serum thyroid-stimulating hormone (TSH)3.1 mU/L (0.4–5.0) serum free T429.8 pmol/L (10.0–22.0)
-serum free T33.5 pmol/L (3.0–7.0)

What is the most likely interpretation of her thyroid function test results?

A 42-year-old woman presented with a 6-month history of tiredness. She also had a history of hypothyroidism, for which she was taking levothyroxine 150 micrograms daily, and a family history of hyperactivity syndrome. Examination was normal.

Investigations:
serum thyroid-stimulating hormone12.3 mU/L (0.4–5.0) serum free T418.0 pmol/L (10.0–22.0)
What is the most likely diagnosis?

A 36-year-old man of South Asian origin presented acutely with a widespread pruritic rash involving the extensor surfaces of the limbs.
On examination, he was moderately obese with a body mass index of 33 kg/m2 (18–25), and the rash was erythematous, with multiple small papules with yellow centres.

Investigations:
-fasting plasma glucose11.0 mmol/L (3.0–6.0) haemoglobin A1c109 mmol/mol (20–42) serum cholesterol8.0 mmol/L (<5.2)
-serum HDL cholesterol0.80 mmol/L (>1.55)
-fasting serum triglycerides31.00 mmol/L (0.45–1.69)

What is the most likely diagnosis?

A 26-year-old woman was recovering from diabetic ketoacidosis and had been switched to her usual basal bolus insulin regimen. Her capillary blood glucose measurements during the day were high but fasting plasma glucose was in the range 5.0–7.0 mmol/L (3.0–6.0). She was drinking and eating normally.
On examination, her pulse was 76 beats per minute and her blood pressure was 106/66 mmHg. Urinalysis showed ketones 1+.

Investigations:
-serum sodium143 mmol/L (137–144) serum potassium4.4 mmol/L (3.5–4.9) serum bicarbonate22 mmol/L (20–28) serum creatinine72 µmol/L (60–110)
-plasma glucose 2 h after breakfast21 mmol/L

What is the most appropriate next step in management?