CASE STUDY 1

A 55-year-old woman reports intense thirst and recurrent vaginal thrush infections. On further questioning, she describes frequent trips to the toilet and blurring of her vision.

A physical examination reveal a height of 5’3” (1.60m), weight of 12 stone 9lbs (80kg), and blood pressure of 160/100mmHg (normal <140/90). A simple “pin-prick” blood test reveals a random blood glucose of 17mmol/ L (normal < 11.1 mmol/ L).

A provisional diagnosis of type 2 diabetes is made.

1. Comment on the presenting symptoms, and explain the physiological processes that lead to their presentation in this patient.
2. How would you interpret the physical examination and blood test?

(BMI = weight (kg)/height (m)² Ideal 18.5 – 25; overweight 25 – 30; obese 30 – 40

3. If left untreated, this patient is at increased risk of which of the following (circle all those that are appropriate):

nephropathy, hypoglycemia, retinopathy, myocardial infarction, stroke, neuropathy, diabetic ketoacidosis, muscle-wasting, hyperglycemia, cold intolerance, postural hypotension

4. How should this patient be managed?

CASE STUDY 2

A 50-year-old man reports weight loss, despite increased appetite and more frequent bowel movements over the recent weeks. His resting heart rate is 82bpm and his blood pressure is 110/76. He complains of palpitations. The doctor notices that there is also a slight bulging of the eyes and firmness around the front of the neck.

1. What is your initial diagnosis?
2. Which symptoms are consistent with your diagnosis? Explain how these symptoms arise.
3. Regarding your diagnosis, is this a primary or secondary endocrine disorder? Explain your answer.
4. What would you expect the levels of T3, T4, and TSH to be in this patient?

Finally, in a second patient with a lack of iodine in the diet:

1. a) Thyroid hormones: high or low?
2. b) Is this hypothyroidism or hyperthyroidism?
3. c) Levels of TSH – low, normal, or high?
4. d) Presence of a goitre?