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His morning cortisol and serum electrolytes were within normal ranges, excluding adrenal insufficiency (Table 1)

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Who to refer: Patients: with symptoms suggestive of either a spinal cord lesion (subacute combined degeneration or peripheral neuropathy) or visual (optic neuropathy) – same day emergency admission not responding haematologically to B12 replacement therapy (where folate and iron stores have been checked and are normal) with suspected malabsorption or disease of the terminal ileum should be referred to Gastroenterology with neurological symptoms should be discussed with Neurology if advice required