Endocrine and Metabolic

A 46-year-old woman has a body mass index of 32 kg/m² and treated hypertension. Her mother developed type 2 diabetes at 58 years of age. She has no polyuria, po…

A 24-year-old woman with type 1 diabetes presents with abdominal pain, vomiting and deep breathing. Her blood glucose concentration is 24 mmol/L, venous pH is 7…

A 76-year-old woman taking denosumab for osteoporosis develops pain around a mandibular molar and undergoes extraction. Twelve weeks later, a segment of hard ti…

A 45-year-old man attends a health assessment. He has a sedentary occupation, a waist circumference of 108 cm and a first-degree relative with type 2 diabetes,…

A 28-year-old man with type 1 diabetes uses a continuous subcutaneous insulin infusion. He develops nausea after the pump gives an occlusion alarm; his blood gl…

A 31-year-old woman with type 1 diabetes is being treated for diabetic ketoacidosis with intravenous insulin and 0.9% sodium chloride. Four hours later, her blo…

A 24-year-old man with type 1 diabetes presents with vomiting and abdominal pain. His blood glucose concentration is 28 mmol/L, blood ketones are 6.4 mmol/L and…

A 34-year-old woman taking carbimazole for Graves disease presents with fever, malaise and two painful oral ulcers. She has a temperature of 38.7°C and mild cer…

A 58-year-old man with primary adrenal insufficiency is scheduled for multiple dental extractions under general anaesthesia. He takes hydrocortisone 20 mg in th…

A 46-year-old woman taking prednisolone 7.5 mg each morning for polymyalgia rheumatica requires extraction of one mobile premolar. She is otherwise well, has ta…

A 38-year-old woman presents with two weeks of pain in the front of her neck radiating to her jaw, together with palpitations, sweating and 2 kg of weight loss.…

A 64-year-old man with type 2 diabetes has an HbA1c of 62 mmol/mol (7.8%) despite maximal-dose metformin and attention to diet and activity. He had a myocardial…

A 52-year-old man has a blood pressure of 162/98 mmHg despite adequate doses of perindopril, amlodipine and hydrochlorothiazide, with good adherence confirmed.…

A 34-year-old woman with known autoimmune Addison disease presents with vomiting, abdominal pain and profound weakness. Her blood pressure is 82/48 mmHg, sodium…

A 29-year-old man has progressive bone pain, proximal weakness and two atraumatic metatarsal fractures. Serum phosphate is 0.44 mmol/L (0.80–1.50), calcium is 2…

A 63-year-old woman reports several months of bone pain and difficulty climbing stairs. She has no focal neurological deficit. Serum calcium is 2.19 mmol/L (2.1…

A 48-year-old woman has a slowly enlarging thyroid nodule, intermittent diarrhoea and facial flushing. Her TSH is 1.6 mIU/L (0.4–4.0), and serum calcitonin is 1…

A 61-year-old man has a 1.5-cm thyroid nodule with a solid markedly hypoechoic appearance, irregular margins and punctate echogenic foci on ultrasound. His TSH…

A 52-year-old woman has progressive headaches and difficulty seeing objects to either side. MRI shows a 2.6-cm sellar mass elevating and compressing the optic c…

A 44-year-old man has an incidental 8-mm pituitary lesion discovered during MRI for headaches. He has normal visual fields, normal pituitary hormone testing, an…