We are going to focus on a clinical case. Please read through the case and then write answers for
each of the questions. Marks are allocated to each part of the question so please work your
way through and provide support for your detailed answers with relevant evidence and
references.
The notional word count is 2000 words in total. In addition please ensure that you reference
your answer fully and appropriately.
A 59 year old lady is referred to your Endocrine Unit complaining of a 2 year history of
flushing. You recognise that the differential diagnosis is wide. No further details are
available from the referral letter.
Describe the key points to determine in the clinical history and examination with
explanations (5 marks)
Outline the differential diagnosis of flushing in a lady of this age. (3 marks)
Describe the investigations you would do to help elicit the underlying diagnosis (2 marks)
One of the investigations that you perform is a 48-hour urine collection for SHIAA. The
results for each 24 hour period are 149 mmoI/24 hours and 200 mmol/24 hours (upper limit
of normal is SOmmol/24 hours)
What aspects of the urine collection should you consider as the potential cause for this? (2
marks)
What initial radiological investigation would you request and what features would you be
looking for? (3marks)
What additional investigations (non-radiological and radiological) would you request at the
same time as requesting this (3 marks)
It transpires that the diagnosis based on all of your findings is likely to be a midgut carcinoid
tumour which has already metastasised to the liver.
Describe the treatments available both current and new, for this condition, explaining how
these therapies act and what they can achieve together with the evidence that supports this.
Prioritise how you would approach the management of this patient and explain your
reasoning (6 marks)