29/01/2025 – Endo and Neuro

Question Easy:
🚨 A 45-year-old man presents with increased thirst, frequent urination, and unintentional weight loss over the last three months. His blood glucose level is 12 mmol/L. What is the most likely diagnosis?
A) Diabetes insipidus
B) Type 2 diabetes mellitus
C) Type 1 diabetes mellitus
D) Hyperthyroidism
E) Addison’s disease

Question Medium:
🧠 A 28-year-old woman presents with episodes of sudden, severe headaches, palpitations, sweating, and anxiety lasting around 10 minutes. Her blood pressure reads 170/100 mmHg during an episode. Which endocrine disorder should be considered?
A) Cushing’s syndrome
B) Pheochromocytoma
C) Hyperthyroidism
D) Graves’ Disease
E) Addison’s disease

Question Hard:
🌡️ A 32-year-old woman presents with fatigue, constipation, hair loss, and cold intolerance. Thyroid function tests reveal high TSH and low free T4. She is currently taking levothyroxine 75 mcg daily. Despite adherence to medication, her symptoms persist. What is the most likely reason for her symptoms?
A) Non-adherence to medication
B) Underlying diabetes mellitus
C) Chronic kidney disease
D) Malabsorption of medication
E) Incorrect initial diagnosis

Explanations & Answers:

Question Easy Answer: B) Type 2 diabetes mellitus
Question Easy Explanation: This patient presents with classic symptoms of type 2 diabetes, including polyuria, polydipsia, and unexplained weight loss, coupled with a random blood glucose level indicative of diabetes. NICE guidelines support considering diabetes mellitus when a patient presents with these symptoms at such glucose levels.

Question Medium Answer: B) Pheochromocytoma
Question Medium Explanation: The patient’s symptoms are consistent with pheochromocytoma, a catecholamine-secreting tumour. The episodic nature of hypertension and associated symptoms like headaches, palpitations, and sweating align with this diagnosis. NICE advises considering this in patients with resistant or episodic hypertension.

Question Hard Answer: D) Malabsorption of medication
Question Hard Explanation: Despite adherence, persistent symptoms and abnormal thyroid function tests suggest possible malabsorption of levothyroxine. Factors such as the timing of medication intake and interactions with other substances, including calcium or iron supplements, could affect absorption. NICE notes that malabsorption should be ruled out in cases of unusual symptom persistence in well-adhered medication regimens.

Medical fact of the day: Did you know? The human brain, weighing just about 1.4 kg, uses approximately 20% of the body’s energy while at rest! This highlights the importance of nourishment and energy for maintaining optimal neurological function.

Quote of the day: “In the art of healing, compassion is as vital as skill; together, they transform lives one touch at a time.”