December 8th, 20140529A middle-aged woman presented with bifrontal headache. On examination, she was noted to have acromegalic features:
Prominent supraorbital ridges
Prognathism with protrusion of the lower jaw
Malocclusion and increased interdental separation
Large hands with broad palms, spatulate fingers and sweaty...
December 8th, 20140381The left and middle photos are those on presentation, while the photo on the right is post-surgery.
A middle-aged woman presented with worsening glycaemic control. On examination, she was noted to have Cushingoid features:
Truncal obesity, relatively thin arms and legs
Wasting of limbs, bruising and proximal muscle...
December 8th, 20140275An elderly woman presented with isolated raised serum alkaline phosphotase level. On examination, she was noted to have the following features:
Enlarged skull with frontal bossing
Anterior bowing of legs
Other significant findings
Kyphosis secondary to osteoporotic vertebral collapse
December 8th, 20140315A young woman presented with weight loss, hand tremor and heat intolerance for 2 months. On examination, she was found to have a diffuse goiter with thyroid bruit and features of Graves' ophthalmopathy.
Other important signs in Graves' disease
Lid lag, lid retraction, chemosis, ophthalmoplegia
Pre-tibial myxoedema (bilateral...
December 8th, 20140233A young man referred for hyperlipidaemia. He has strong family history of hypercholesterolaemia and ischaemic heart disease. On examination, he was noted to have tendinous xanthoma. His lipid profile showed a total cholesterol of 14.0 mmol/L, an LDL of 9.6 mmol/L and a triglyceride of 2.2 mmol/L and an HDL of 1.2 mmol/L. He was treated...
December 8th, 20140223A middle-aged man, who was also a chronic drinker, presented with acute pancreatitis. On examination, he was noted to have eruptive xanthomata. His triglyceride level was 20 mmol/L. He was treated with fenofibrate (a fibrate).
December 8th, 20140320A middle-aged woman presented with malaise and cold intolerance. She had radioactive iodine treatment for her thyrotoxicosis more than 10 years ago but defaulted follow-up shortly after treatment. Her thyroid function showed a fT4 of 5 pmol/L (N: 12-23 pmol/L) with a TSH of 150 mIU/L (N: 0.35 – 4.5). She was treated as post RAI...
December 6th, 20140242A post-menopausal woman presented with visual blurring. On confrontation testing, she was found to have bitemporal hemianopia. MRI of her pituitary showed a 1.8cm pituitary macroadenoma (i.e. largest dimension >/= 1cm). Her serum prolactin was 890 mIU/L (N: <620 mIU/L), likely due to stalk effect. She also had central...