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Old 10-20-2011
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Default (Endocrine)

A 32-year-old man has a gradual onset of headaches, fatigue, and myalgia. He has been previously healthy and is not taking any medications. There has been no vision change or syncope. Examination shows an enlarged tongue, spaced teeth and a doughy skin appearance. Laboratory studies show elevated insulin like growth factor (IGF-I) and prolactin levels. His serum glucose is 150 mg/dL. A glucose tolerance test is abnormal. Which of the following is the most likely cause of these findings?



A.

Diabetes mellitus


B.

Insulinoma


C.

Pituitary adenoma


D.

Pheochromocytoma


E.

Prolactinoma
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Old 10-20-2011
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C. Pituitary adenoma???
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Old 10-20-2011
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Default Answer

The correct answer is C. Growth hormone excess in adults leads to acromegaly. Laboratory findings include an abnormal glucose test whereby the growth hormone concentration is elevated 1 hour after oral administration of 100 grams of glucose. Mild hyperprolactinemia can be noted. The most frequent cause for the condition is a pituitary adenoma. An hour after glucose administration, growth hormone should normally be suppressed to a value less that 1 mcg/L. IGF-I concentrations are high because of a high level of growth hormone.
Glucose tolerance testing is a useful screening test for diabetes mellitus and glucose intolerance is often seen in acromegaly. The patient may have diabetes but further testing will be needed (choice A).
An insulinoma (choice B) would be characterized by hypoglycemia, decreased glucose levels after a glucose challenge and elevated levels of insulin.
Pheochromocytoma (choice D) is characterized by paroxysms of hypertension. Evaluation will involve 24-hour collection of urine metanephrines, and abdominal scanning to evaluate for an adrenal mass.
Prolactinoma (choice E) will cause an elevated level of serum prolactin. Acromegaly can present with mildly elevated prolactin levels as well and scanning of the head should be undertaken to define the presumptive pituitary adenoma since acromegaly is most often caused by a pituitary adenoma.
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