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SEND - Endocrinology and Diabetes (Specialty Certificate Examination) Questions 26–30 (page: 7)

A 37-year-old man, who had previously undergone female-to-male gender reassignment surgery, attended the endocrine clinic for annual review. He had no complaints and was happy with the results of his treatment. His medication consisted of testosterone undecanoate 1 g intramuscularly every 3 months.
What variable is it most important to monitor?

A 54-year-old man was referred from the urology department with erectile dysfunction.
On examination, he had normal secondary sexual characteristics. Testicular volume was estimated at 15 mL bilaterally.

Investigations:
-random plasma glucose8.0 mmol/L serum testosterone8.1 nmol/L (9.0–35.0)
-plasma follicle-stimulating hormone3.4 U/L (1.0–7.0) plasma luteinising hormone4.7 U/L (1.0–10.0)
-serum prolactin410 mU/L (<360)

What is the most appropriate next step in management?

A 42-year-old policewoman presented with thirst, polyuria and tiredness of 3 months’ duration. She gave a family history of thyrotoxicosis.
On examination, her pulse was 108 beats per minute and her blood pressure was 150/70 mmHg. She had a fine tremor and diffuse thyroid enlargement. She also had mild proptosis.
Investigations:

-haemoglobin146 g/L (115–165) platelet count164 ? 109/L (150–400) serum sodium143 mmol/L (137–144) serum creatinine135 µmol/L (60–110)
-serum corrected calcium3.60 mmol/L (2.20–2.60)
-serum thyroid-stimulating hormone<0.02 mU/L (0.4–5.0) serum free T431.9 pmol/L (10.0–22.0)
-serum free T315.6 pmol/L (3.0–7.0)

What is the most appropriate next investigation?

An 80-year-old man was referred because of weight gain and low mood but said he was otherwise well. He had a complex cardiac history including a ventricular fibrillation arrest and a permanent pacemaker, but he had been very well for the past 3 years. He was taking amiodarone 100 mg daily, lisinopril 40 mg daily and furosemide 80 mg daily.
On examination, he had a pacemaker in situ and his pulse was 84 beats per minute and regular. He had a 2/6 mid-systolic murmur in the aortic area with no radiation, mild ankle oedema, and scanty basal crackles bilaterally on auscultation of his chest.
Investigations (before attending clinic):

-serum thyroid-stimulating hormone19.0 mU/L (0.4–5.0) serum free T411.0 pmol/L (10.0–22.0)
-anti-thyroid peroxidase antibodies300 IU/mL (<50)

What is the most appropriate next step in management?

A 52-year-old man, with a 20-year history of type 2 diabetes mellitus, had been treated with metformin and, for the previous 4 years, biphasic insulin aspart twice daily. He had recently started a new job that required him to drive a 7.5-tonne vehicle.
If he were to apply for a UK Class C1 driving licence, who should complete the application form with him?