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Clinical Follow-up Question

Diabetes mellitus was recently diagnosed in a 43-year-old woman when she was noted on routine clinical evaluation to have a fasting plasma glucose level of 154 mg/dL (8.5 mmol/L).

Other abnormal laboratory values:

AST = 119 U/L (20-48 U/L)   (SI: 2.0 µkat/L [0.33-0.80 µkat/L])
ALT = 134 U/L (10-40 U/L)   (SI: 2.3 µkat/L [0.17-0.67 µkat/L])
Hemoglobin A1c = 6.9% (4.0%-5.6%)   (52 mmol/mol [20-38 mmol/mol])

She has no family history of diabetes, but several relatives have had liver disease of uncertain cause. Review of systems is notable for oligomenorrhea for 2 years and amenorrhea for 3 months. On physical examination, she has a mildly enlarged, nontender liver, no ascites or other signs of chronic liver disease, and no edema. Liver ultrasonography shows a mildly enlarged liver without masses, no evidence of steatosis, and no biliary disease. Hepatitis (A, B, C) serologies are negative or suggestive of previous infection.

Which of the following tests is most likely to reveal the etiology of her diabetes?
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Lead to benefits for your patients?

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