40 Year Old Man With Prominent Supra Orbital Ridges And A Large Lower Jaw

A 40 year old man comes to his primary care physician because he himself as well as his friends and family have noticed changes in his facial features. Patient was recently diagnosed with diabetes mellitus and has also noticed that he sweats excessively.
On examination the patient appears to be a tall man with prominent supra orbital ridges, ans a large lower jaw. His hands and feet appear to be large and his skin seems to be thickened and greasy.

The patients picture taken in the doctor's office is shown below:

What is the diagnosis?

Acromegaly.

What other endocrine disorders a patient with acromegaly may have?


Answer:
1. Diabetes mellitus may occur in 10-20% of cases but it is mild and ketoacidosis is rare.
2. Hypertension in 20-50% of cases.
3. Hypercalciuria and Hypercalcemia
4. Urolithoasis in 5-10 % of cases.
5. Goiter
6. Acanthosis nigricans
7. Hypogonadism

What investigation will you suggest for this patient/

Answer:
1. Insulin like growth factor 1, it is a good screening test but not diagnostic.
2. Glucose tolerance test with growth hormone response. (+ve when there is lack of suppression)
3. MRI scan of pituitary fossa
4. Visual field examination.
5, Tests for anterior pituitary function.