Weight Disorder

A 38-year-old woman presents with complaints of increased sweating, fatigue, and changes in her appearance over the past 2 years. She notes her facial features have become more "coarse," and her coworkers have commented on her deepening voice. She also mentions joint pain, especially in her knees and wrists. On the physical exam, she has an enlarged tongue (macroglossia), thickened skin, and enlarged hands. Blood tests reveal elevated insulin-like growth factor 1 (IGF-1).

Which of the following is the most appropriate initial diagnostic test to confirm acromegaly?

• Pituitary MRI

• Random serum growth hormone (GH) level

• Oral glucose tolerance test (OGTT) with GH measurement

• Skull X-ray to look for enlarged sella turcica

A 38-year-old man presents with fatigue, weight loss, postural hypotension, and skin hyperpigmentation. Blood tests show low morning serum cortisol and elevated ACTH. To confirm the diagnosis of primary adrenal insufficiency, which of the following is the most appropriate next step?

• Dexamethasone suppression test

• ACTH stimulation

• 24-hour urinary free cortisol

• Low-dose dexamethasone test

• Plasma renin and aldosterone levels

A 36 year old lady presents with a history of excessive weight for last 6 months. She says her weight gain over this period is 5kg,. She feels depressed and noticed diminished libido. She has no significant past medical illness neither has she underwent any surgery. On examination, she is obese with BP 160/95mmHg and face is flushed. There is no oedema.
If one of the differential diagnosis is Cushing’s syndrome, what is the one specific feature you would look for in this patient?

• depression

• decreased libido

• amenorrhea

• Hypertension

A 45-year-old man presents to your clinic with complaints of increased shoe and ring size over the past 2 years. He also reports frequent headaches, excessive sweating, and joint pain, especially in his hands and knees. On examination, he has coarse facial features, prominent supraorbital ridges, a broad nose, and macroglossia. His blood pressure is 150/95 mmHg, and his fasting blood glucose is elevated. Visual field examination reveals bitemporal hemianopia.

Which of the following is the most appropriate initial investigation to confirm the diagnosis?

• Random serum growth hormone (GH) level

• MRI of the pituitary gland

• Serum insulin-like growth factor 1 (IGF-1) level

• Oral glucose tolerance test (OGTT) with GH measurement

• Visual evoked potential (VEP)

A 52-year-old woman presents with mild fatigue and weight gain over the past few months. She denies cold intolerance, constipation, or hair loss. Physical examination is unremarkable. Laboratory results reveal:  

-TSH: 7.1 mIU/L (normal 0.4–4.5)  

-Free T4: 1.0 ng/dL (normal 0.8–1.8)  

What is the most likely diagnosis?

• Primary hypothyroidism

• Subclinical hypothyroidism

• Secondary hypothyroidism

• Graves’ disease

A 55-year-old woman with metastatic pancreatic cancer attends the oncology clinic prior to her second cycle of chemotherapy. She tolerated her first cycle well but her husband mentions that there have been occasions where she has been confused. Her urea and electrolyte blood tests reveal a serum sodium of 116mmol/L. All other results were within the normal range. The chemotherapy is delayed and a urine specimen is sent off. This reveals a urine osmolality of 620mmol/kg. The most likely cause of the hyponatraemia is:

• Water overload

• Diabetes insipidus

• Addison’s disease

• Syndrome of inappropriate anti-diuretic hormone

• Renal impairment

A 45-year-old man presents with gradual weight gain over the past year, particularly in the trunk and neck areas. He also reports decreased libido, muscle weakness, and feeling cold all the time. Physical examination reveals bradycardia, dry skin, and periorbital puffiness. His BMI is 32 kg/m².

Which of the following is the most appropriate initial investigation?

• Serum insulin level

• Serum cortisol level

• Thyroid-stimulating hormone (TSH)

• Serum testosterone

A 30-year-old female presents with hypertension. On separate visits, she has had BP of 160/110 mmHg. She has been previously healthy and denies any symptoms. She has a strong family history of hypertension and dyslipidemia. Her investigation revealed elevated serum Na+ and hypokalemia.

What is the most likely diagnosis?

• Cushing Disease

• Conn Syndrome

• Pheochromocytoma

• Carcinoid syndrome

A 38-year-old woman has 6 months of weight gain (central), moon face, purple stretch marks, muscle weakness, and hypertension. Labs show high urinary cortisol and no suppression with low-dose dexamethasone.

What is the most likely cause?

• Adrenal adenoma

• Pituitary ACTH-producing adenoma

•  Ectopic ACTH from lung cancer

• Exogenous steroid use

A 55-year-old female presented with frequent sweating, palpitations and diarrhoea. She also reported losing 3 kilograms over the past month. She has a history of atrial fibrillation.
What is the most likely cardiac sequelae of her condition?

• Myocardial infarction

• High output cardiac failure

• Ventricular aneurysm

• Pericardial effusion

• Prolonged QT interval