48-year-old male patient with hypertension and type 2 diabetes came to your clinic complaining of headaches and joint pain. He noted that his ring size started to increase over the last 2 years. On physical exam: Blood Pressure 160/93 mmHg, HIR 89, RR 17, A febrile. His palms are sweaty and have several skin tags. He has a large nose, lips, and jaw. His teeth are widely spaced. Heart auscultation revealed a pansystolic murmur radiating to the axilla. What is the next diagnostic workup modalities?
سؤال مجاني 5 من 10 اليوم · اشترك وكمّل بدون حد
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الإجابة: A. MRI Pituitary and IGF-1 level
Coarse features, increasing ring size, sweating, skin tags, HTN and DM = acromegaly. Work-up: serum IGF-1 is the best single (initial) test, and pituitary MRI is the imaging of choice.
- A random GH level is not useful (wide physiological fluctuation), and CT is inferior to MRI for the pituitary — so B is wrong.
- Renin/aldosterone and echo/troponin don't diagnose the cause.
ليش كل خيار صح أو غلط
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A
ليش صح
Large nose and jaw, ring size, sweaty palms, HTN and diabetes = acromegaly: IGF-1 is the best single test and pituitary MRI is the imaging modality of choice.
✓ Pituitary disorder.pdf · p. 9 -
B
ليش غلط
A random GH level is not useful because GH fluctuates widely physiologically; serum IGF-1 is the best single test.
✓ Pituitary disorder.pdf · p. 9 -
C
ليش غلط
An adrenal / renin-aldosterone work-up does not fit: this picture is acromegaly, whose work-up is IGF-1, then OGTT, then pituitary MRI.
✓ Pituitary disorder.pdf · p. 9 -
D
ليش غلط
The murmur and cardiac findings are a complication of acromegaly (hypertrophic cardiomyopathy), not the diagnostic work-up of its cause.
✓ Pituitary disorder.pdf · p. 9
- المصدر
- Pituitary disorder.pdf · p. 9
- المحاضرة
- Pituitary Disorders · Endocrinology · Module B
- ظهر في
- Endo bank