Question

QUESTION 1 A 44 yr old male was referred to his physician for occasional headaches, progressive visual impairment, and loss of sex drive over the last six months. He also reports a gradual increase in shoe size and glove size over the last few years. Suspecting an endocrine disorder, the doctor orders biochemical testing-the results are shown below. Random Growth Hormone: 12.5 ng/ml (<5 ng/ml) IGF1 (Insulin like Growth Factor 1): elevated Testosterone: 700 ng/dL (270-1070 ng/dL) Plasma Glucose (fasting) : 145 (<126 mg/dL) Prolactin: 10 ng/mL (2-18 ng/mL) a. What is the likely diagnosis based on patient symptoms and biochemical test results? b. What non-biochemical evidence can the physician request from the patient to confirm diagnosis? C. Explain a biochemical test that can be used to confirm the diagnosis d. What is the significance of the fasting glucose level? How is it correlated to the primary diagnosis? e. Does this patient have a endocrine disorder that affects his entire pituitary function? Use the results to explain why or why not.

Answer 1

a. Acromegaly as in this condition pituitary gland starts making more growth hormone that results in enlargement of hands and feet in addition to overall enlarged facial feature and many other symptoms.

b. enlargement of hands and feet, visual impairment abd occasional headaches support the diagnosi

c. Oral glucose tolerance test is used to confirm he test as there is relation between growth hormone and blood glucose level. Elevated glucose level decreases the growth hormone level in normal case but if there is no such drop, acromegaly is there

d. Plasma fasting glucose level will tell the presence of diabetes mellotus. Acromegaly is an uncommon secondary cause of diabetes. Excess GH: 1) stimulates gluconeogenesis and lipolysis, causing hyperglycemia and elevated free fatty acid levels; 2) leads to both hepatic and peripheral insulin resistance, with compensatory hyperinsulinemia.

e. this disorder has not affected his entire pituitary function . It is only anterior pituitary lobe that is involved as the level of prolactin is in normal range and that hormone is secreted by posterior lobe of pituitary gland.