Challenging Cases In Endocrinology

Question 1

New onset of recurrent hypoglycaemia without change in intake or dose

Answer 1

Check for worsening eGFR
Adrenal insufficiency - especially in DM1

Question 2

Sarcoidosis induced hypercalcaemia

Answer 2

Sarcoidosis tissues contains 1-25-VitDase

Question 3

Sarcoidosis induced hypercalcaemia

Answer 3

Sarcoidosis tumours contains 1-25-VitDase

Question 4

Factitious thyrotoxicosis

Answer 4

Exogenous thyroxine suppresses serum thyroglobulin - low
Other causes of low thyroglobulin - thyroidectomy -> great marker to monitor recurrent

Question 5

New onset hypoglycaemia from alcoholic cirrhosis
Worsened/no improvement with glucagon

Answer 5

Liver failure
No glycogen storage in liver

Question 6

Hyperglycaemia, loss of weight, rashes

Answer 6

Glucagonoma syndrome

Question 7

HIV treatment with fluticasone use

Answer 7

HIV drugs suppresses CYP460 pathway, leading to reduced metabolism of fluticasone

Question 8

Old age hirsutism with obesity, acathosis nigricans, elevated testosterone

Answer 8

Severe insulin resistance
Check for PCOS