A 26-year-old obese female is investigated for menstrual disturbance. A diagnosis of polycystic ovarian syndrome is made.
Which of the following findings is most consistently seen in polycystic ovarian syndrome?
Correct Answer C: Polycystic ovarian syndrome - ovarian cysts are the most consistent feature.
Whilst all of the features listed above may be seen in polycystic ovarian syndrome, ovarian cysts are the most consistent feature.
Polycystic ovarian syndrome: features and investigation: olycystic ovary syndrome (PCOS) is a complex condition of ovarian dysfunction thought to affect between 5- 20% of women of reproductive age. The aetiology of PCOS is not fully understood. Both hyperinsulinaemia and high levels of luteinizing hormone are seen in PCOS and there appears to be some overlap with the metabolic syndrome.
Features:
Investigations:
A 52-year-old man has a set of fasting bloods as part of a work-up for hypertension. The fasting glucose comes back as 6.5 mmol/l. The test is repeated and reported as 6.7 mmol/l. He says he feels constantly tired but denies any polyuria or polydipsia.
How should these results be interpreted?
Correct Answer A:
Diabetes mellitus: diagnosis:
The following is based on the World Health Organization (WHO) 2006 guidelines.
Diabetes mellitus
If the patient is symptomatic:
If the patient is asymptomatic the above criteria apply but must be demonstrated on two separate occasions.
In 2011 WHO released supplementary guidance on the use of HbA1c on the diagnosis of diabetes:
Impaired fasting glucose and impaired glucose tolerance
Diabetes UK suggests:
A 54-year-old female presents to the Emergency Department concerned about double vision. She is noted to have exophthalmos and conjunctival oedema on examination and a diagnosis of thyroid eye disease is suspected.
What can be said regarding her thyroid status?
Correct Answer E:
Thyroid eye disease: Thyroid eye disease affects between 25-50% of patients with Graves' disease. It is thought to be caused by an autoimmune response against an autoantigen, possibly the TSH receptor, which in turns causes retro-orbital inflammation. The patient may be eu-, hypo- or hyperthyroid at the time of presentation.
Prevention:
Management:
Dynamic pituitary function tests may be used to assess each one of the following, EXCEPT:
Dynamic pituitary function tests:
A dynamic pituitary function test is used to assess patients with suspected primary pituitary dysfunction Insulin, TRH and LHRH are given to the patient following which the serum glucose, cortisol, growth hormone, TSH, LH and FSH levels are recorded at regular intervals. Prolactin levels are also sometimes measured*
A normal dynamic pituitary function test has the following characteristics:
*dopamine antagonist tests using metoclopramide may also be used in the investigation of hyperprolactinaemia.
A normal response is at least a twofold rise in prolactin. A blunted prolactin response suggests a prolactinoma.
A 35-year-old female is referred to the endocrine clinic due to weight loss and palpitations. The following results are obtained:
Which one of the following features would most suggest a diagnosis of Grave's disease?
Correct Answer D: Pretibial myxoedema is not seen in other causes of thyrotoxicosis and points towards a diagnosis of Graves'.
Graves' disease: features:
Graves' disease is the most common cause of thyrotoxicosis. It is typically seen in women aged 30- 50 years.
Features seen in Graves' but not in other causes of thyrotoxicosis:
Autoantibodies:
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