Endocrine and Metabolic

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 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 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 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 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 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 58-year-old man is found to have a serum calcium concentration of 2.78 mmol/L (2.15–2.55) on two occasions. His phosphate is 0.72 mmol/L (0.80–1.50), creatini…

A 42-year-old woman has progressive fatigue, reduced appetite and dizziness when standing. Her serum sodium is 127 mmol/L (135–145), potassium is 5.8 mmol/L (3.…

A 72-year-old woman sustains a low-trauma vertebral compression fracture while lifting a light shopping bag. She has no renal impairment, oesophageal disease or…