A 36-year-old woman was referred to the endocrine clinic with abnormal thyroid function tests. She gave a 3-year history of increased sweating and anxiety following an assault and, initially, her symptoms had been attributed to post-traumatic stress disorder.

Investigations:

serum thyroid-stimulating hormone (TSH)3.1 mU/L (0.4C5.0)

serum free T429.8 pmol/L (10.0C22.0)

serum free T33.5 pmol/L (3.0C7.0)

What is the most likely interpretation of her thyroid function test results?

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A 72-year-old woman presented with a painless swelling in the front of the neck, which she had first noticed 2C3 months previously. She was otherwise well, with no symptoms of mass effect in her neck, and was not taking any medication.

On examination, her thyroid gland was moderately enlarged, and felt uniformly nodular. There was no associated lymphadenopathy. Her pulse was 78 beats per minute and regular, and there were no signs of thyrotoxicosis.

Investigations:

serum thyroid-stimulating hormone<0.01 mU/L (0.4C5.0)

serum free T424.8 pmol/L (10.0C22.0)

serum free T310.3 pmol/L (3.0C7.0)

technetium-99m scan of thyroid (20-min uptake)patchy uptake in both thyroid lobes

What is the most appropriate management?

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A 41-year-old man presented to his general practitioner with symptoms of palpitations, sweating and anxiety. His blood pressure was 160/102 mmHg. He was advised to take propranolol 40 mg twice daily but was admitted to hospital later that week with an episode of pulmonary oedema.

On examination at the time of admission, he was noted to be pale and sweating and he had a blood pressure of 210/124 mmHg. A phaeochromocytoma was suspected.

What is the most likely cause of the cardiovascular deterioration following administration of propranolol?

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A 55-year-old man with mild polyuria and tiredness was seen on a renal ward. He had had a living-related kidney transplant 6 months previously. He had good graft function while being treated with prednisolone 5 mg daily, mycophenolate mofetil 1 g twice daily and tacrolimus 3 mg twice daily. He was also taking atenolol 50 mg daily and simvastatin 40 mg daily.

Investigations:

haemoglobin A1c75 mmol/mol (20C42)

random plasma glucose18.0 mmol/L

Which drug is most likely to be responsible for his diabetes of new onset?

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A 45-year-old woman was found to be hypertensive by her general practitioner. She was otherwise well and was not taking any medication. However, she regularly ate health food containing liquorice. There was no family history of significant illness.

On examination, her blood pressure was 170/110 mmHg.

Investigations:

serum sodium140 mmol/L (137C144)

serum potassium3.8 mmol/L (3.5C4.9)

serum creatinine70 µmol/L (60C110)

plasma renin activity (after 30 min supine)0.5 pmol/mL/h (1.1C2.7)

plasma aldosterone (after 30 min supine)450 pmol/L (135C400)

During the investigations, her blood pressure was controlled with doxazosin.

What is the most likely diagnosis?

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Carbimazole is routinely used in the management of thyroid disease.

What does carbimazole inhibit?

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A 76-year-old woman with type 2 diabetes mellitus was reviewed. Treatment with thiazolidinedione was being considered, but she was worried about the effect this medication might have on the incidence of complications. She had known background retinopathy.

What complication is more likely to worsen in a patient taking a thiazolidinedione?

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A 64-year-old man attended the diabetes clinic for annual review. He complained of very recent tingling in his feet. A monofilament was used to screen for the presence of chronic sensorimotor diabetic peripheral neuropathy.

What force should a monofilament deliver?

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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?

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A 19-year-old man presented with late development of his pubic and axillary hair. He was otherwise well and was not taking any medication. His serum testosterone concentration had been normal on two previous occasions.

On examination, he now had post-pubertal secondary sexual characteristics. He had 15C20 mL testes.

Investigations:

serum testosterone27.0 nmol/L (9.0C35.0)

serum sex hormone binding globulin28 nmol/L (10C62)

serum follicle-stimulating hormone2.0 U/L (1.0C7.0)

serum luteinising hormone2.9 U/L (1.0C10.0)

What is the chief product of the Sertoli cell?

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