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Diabetic cardiac autonomic neuropathy — SCE Endocrinology MCQ

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HardDiabetesDiabetic cardiac autonomic neuropathySCE Endocrinology

A 60-year-old man with type 2 diabetes has resting tachycardia, exercise intolerance and dizziness during exertion. HbA1c is 88 mmol/mol and bedside testing shows reduced heart-rate variability with deep breathing. ECG shows sinus rhythm and troponin is normal. What is the most likely biochemical finding?

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Reveal the answer and explanation

Correct answer: C — Normal TSH with normal morning cortisol

The symptoms and autonomic testing support diabetic cardiac autonomic neuropathy, which does not require a primary endocrine biochemical abnormality. Thyrotoxicosis and adrenal insufficiency are distractors for tachycardia and dizziness but do not explain reduced heart-rate variability in long-standing diabetes. The pearl is that cardiac autonomic neuropathy is a neurophysiological complication rather than a hormone-excess state.

Reference: NICE NG28