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17th September 2024
A 36-year-old female presents with dizziness on standing. She was diagnosed with melanoma
A 36-year-old female presents with dizziness on standing. She was diagnosed with melanoma a year ago and has been on pembrolizumab therapy for 8 months. She initially felt tired but her routine blood tests 3 months ago were normal, including haemoglobin, urea, electrolytes, and thyroid function tests. She is not on any regular medication other than pembrolizumab. A blood test is performed at 8:30 am and is shown below.
| Sodium | 135 mmol/l (135-145) |
| Potassium | 5.0 mmol/l (3.5-5.0) |
| TSH | 1 mU/l (0.38-5.33) |
| Free T4 | 11.5 pmol/l (7.9- 14.4) |
| ACTH | 10 pg/ml (10-60) |
| Cortisol | 120 nmol/l (>300) |
| Prolactin | 325 mIU/l (<700) |
| LH | 1.5 mIU/l (2-9) |
| FSH | 1.8 mIU/l (2-12) |
Which of the following tests is the best to diagnose his condition?
Select the SINGLE most appropriate option from the list below. Select ONE option only.
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