Case analysis: Clinical Chemistry Endocrinology

CASE 1
Clinical History and Background

A 45-year-old woman, who had been suffering from oligomenorrhea for a few months, went to her GP
complaining of headaches and blurring of vision. He thought her symptoms might be due to early
menopause, but did a fundoscopy due to the visual symptoms and noted that the fundus looked pale.
He measured her prolactin and gonadotrophins along with routine blood tests. The prolactin result came
back as 2500 mU/L (120 ng/mL). She was referred to an Endocrinologist and underwent dynamic
function testing to assess the pituitary reserve. She underwent a combined anterior pituitary test
(insulin stress test + TRH Test + LHRH Test). The results (including the basal reference ranges) were as
follows:

Questions to answer:

1. What is the diagnosis?

2. Comment on the results of the dynamic function tests.
3. What are the treatment options in this case?
 CASE 2
Clinical History and Background

A 38-year-old man with acromegaly is treated initially with surgery and radiotherapy. Subsequently his
original symptoms of arthralgia, fatigue and sweating recur. Further investigations include an oral
glucose tolerance test. The results are shown below.

Fasting glucose: 6.8 mmol/L (122 mg/dL); 2-hour glucose: 10.3 mmol/L (185 mg/dL).

How would you interpret?

1. Why was this oral glucose tolerance test performed?

2. What else would you measure during the procedure?
3. How would you interpret these glucose results?

CASE 3

Clinical History and Background

A 37-year-old man attends his GP complaining of fatigue. Investigations include Thyroid Function Tests,
the results of which are as follows:

1. Comment on these results.

2. What other investigations should be performed?
3. How should this patient be treated?
 CASE 4

Clinical History and Background

A 25-year-old male cyclist is admitted to a neurosurgical unit after sustaining severe head injuries in
a road traffic accident. He develops polyuria (urine output in excess of 15 L) over the next 24 h.
Serum sodium climbs from 148 mmol/L on admission, to 168 mmol/L on day 4, at which point a
spot urine osmolality is 80 mmol/kg.

Questions to answer:

1. What is the diagnosis?

2. How would you treat his hypernatremia?