ABSTRACT
History and examination A 67-year-old man presents to his GP with dysuria and frequency. He had recently undertaken a strict diet in response to the finding of mild hypertension and hypercholesterolaemia which was also treated with simvastatin and lisinopril. Rectal examination revealed a hard nodule in his prostate. On receiving a report indicating an elevated PSA (prostate-specific antigen) and low % free PSA, he was referred to the urologist. Prostatic biopsy revealed malignancy with Gleason scores of 3 + 4. He chose to be treated with radiotherapy. Later that year he presented with complaints of diarrhoea and blood in his stools. Endoscopy demonstrated diverticular disease. However, because of his cachectic state, a computed tomography (CT) scan of his abdomen was arranged which showed bilateral adrenal nodules. At this time, postural hypotension was noted and he complained of feeling weak and dizzy, but this was ascribed to his cachectic state and anti-hypertensive medication. His bloods were as below (sample taken at home).
