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SEND - Endocrinology and Diabetes (Specialty Certificate Examination) Questions 16–20 (page: 5)

A 72-year-old man with a 12-year history of type 2 diabetes mellitus was found to have carcinoma of the bladder. He was taking metformin; however, this was stopped because of his deteriorating renal function. On examination, his weight was 95 kg and his body mass index was 32 kg/m2 (18–25).
Investigations:

-serum sodium143 mmol/L (137–144) serum potassium4.4 mmol/L (3.5–4.9) serum creatinine175 µmol/L (60–110)
-estimated glomerular filtration rate (MDRD)27 mL/min/1.73 m2 (>60) haemoglobin A1c64 mmol/mol (20–42)

What is the most appropriate addition to his medication?

A 24-year-old woman was referred with an 18-month history of worsening hirsutism, primarily on her face, but also new hair growth on her chest. She was shaving weekly. She had always been overweight, but had recently gained 5 kg and her body mass index was 31 kg/m2 (18–25). Her periods were regular.
What is the most relevant next investigation?

A 77-year-old woman presented with a 10-week history of facial hirsutism, scalp hair loss and deepening of the voice.
On examination, her body mass index was 32 kg/m2 (18–25). Her blood pressure was 164/94 mmHg. She had coarse terminal hairs on her upper lip and beard areas. Abdominal examination was normal, but she refused examination of her external genitalia.
Investigations:

-serum sodium144 mmol/L (137–144) serum potassium3.6 mmol/L (3.5–4.9) serum urea7.7 mmol/L (2.5–7.0) serum creatinine122 µmol/L (60–110)
-fasting plasma glucose6.4 mmol/L (3.0–6.0) serum testosterone17.2 nmol/L (0.5–3.0) serum luteinising hormone2.2 U/L (>30.0)

What is the most appropriate initial investigation?

A 27-year-old woman with type 1 diabetes mellitus was invited to attend a structured education (e.g. DAFNE) course. Which quality of life domain is most affected when a person is found to have type 1 diabetes mellitus?

A 44-year-old man was referred for investigation of cortisol excess. He had poorly controlled hypertension, and a long history of type 2 diabetes mellitus with retinopathy and peripheral neuropathy. His medication comprised aspirin, ramipril, atenolol, carbamazepine, metformin and simvastatin.

Initial investigations:

-serum cortisol (09.00 h)350 nmol/L (200–700)
-serum cortisol (22.00 h)48 nmol/L (50–250)
-overnight dexamethasone suppression test (after 1 mg dexamethasone): serum cortisol93 nmol/L (<50)
-24-h urinary free cortisol (day 1)225 nmol (55–250) 24-h urinary free cortisol (day 2)200 nmol (55–250)
-24-h urinary free cortisol (day 3)185 nmol (55–250)

What is the most appropriate next step in management?