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23rd April 2024
A 42-year-old female presents with 4 months of fatigue. Her past medical history includes obesity
A 42-year-old female presents with 4 months of fatigue. Her past medical history includes obesity, type 2 diabetes, hypercholesterolaemia, and Sjogren’s. She has a sister with Type 1 diabetes. She does not smoke. She drinks alcohol on the odd occasion with friends but does not drink to excess. On examination, there are no stigmata of chronic liver disease. There are yellow plaques on both eyelids, and she is obese.
Investigations show the following:
| Haemoglobin | 130/l |
| White Cell Count | 9.0*10⁹/l |
| Neutrophils | 6.5*10⁹/l |
| Platelets | 320*10⁹/l |
| Sodium | 133 mmol/l |
| Potassium | 3.7 mmol/l |
| Urea | 5.2 mmol/l |
| Creatinine | 68 µmol/l |
| CRP | 12 mg/l |
| ESR | 42 mm/hr |
| Bilirubin | 12 µmol/l |
| Alkaline Phosphatase | 350 u/l |
| Gamma-T | 120 u/l |
| ALT | 45 u/l |
| AST | 35 u/l |
| Albumin | 35 g/l |
What would be the most useful investigation to make the diagnosis?
Select the SINGLE most appropriate option from the list below. Select ONE option only.
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