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 55-year-old woman presented with thirst, polyuria and polydipsia. Her symptoms had started 9 months previously following a road traffic accident. Her past medical history was normal and she was not taking any regular medication.
On examination, her blood pressure was 130/80 mmHg with no postural drop. Urine volume measured 5 L in 24 hours.
Investigations:
serum sodium131 mmol/L (137–144)
serum potassium3.6 mmol/L (3.5–4.9)
serum urea2.0 mmol/L (2.5–7.0)
serum corrected calcium2.40 mmol/L (2.20–2.60)
fasting plasma glucose6.4 mmol/L (3.0–6.0)
serum osmolality278 mosmol/kg (278–300)
urinary osmolality100 mosmol/kg (100–1000)
What is the most likely diagnosis?
A 67-year-old woman presented to her general practitioner with a swelling in her neck. It had been present for 4–5 years and had not changed in size during that time. She was completely asymptomatic and remained well.
On examination, there was a nodular goitre and no lymphadenopathy.
Investigations:
serum thyroid-stimulating hormone1.1 mU/L (0.4–5.0)
A subsequent ultrasound scan demonstrated seven nodules bilaterally (ranging in size from 5 mm to 15 mm), which had no suspicious features.
What is the most appropriate next step in management according to British Thyroid Association 2014 Guidelines for the Management of Thyroid Cancer?
A 64-year-old woman presented with features of acromegaly. An MR scan showed a pituitary tumour with cavernous sinus extension. She underwent trans-sphenoidal surgery and histology of the pituitary tissue showed numerous cells immunostaining for growth hormone.
Investigations (6 months postoperatively):
MR scan of pituitaryenlarged sella, residual tumour in right cavernous sinus
serum growth hormone (day curve average)3.2 ?g/L (<2)
serum insulin-like growth factor 142.0 nmol/L (3.3–23.3)
What is the most appropriate next step in management?
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