Question

A 45-year-old man with history of previously well-controlled hypertension comes in because colleagues at his office are telling him that his appearance is changing. The patient has recently noted that his old shoes felt too tight and he had to buy new, larger shoes. He also complains of shooting pains in his hands which his company nurse told him were consistent with carpal tunnel syndrome. Review of systems reveals increased thirst and urination. His temperature is 37.0°C (98.6°F), blood pressure 190/90 mm Hg, pulse 73/min, and respirations 13/min. Physical examination shows frontal bossing, mandibular enlargement, and widening of the spaces between his teeth. His hands and feet seem larger and more out of proportion to his body size than usual.

Which of the following is the most appropriate diagnostic study at this time?

A. Cortisol level
B. CT scan of brain
C. Fasting glucose level
D.Growth hormone levels
E. Insulin-like growth facto

Answer 1

The most appropriate initial diagnostic study for a patient with signs of acromegaly is to measure growth hormone levels, which would likely be followed by a glucose tolerance test and possibly a CT scan of the brain.

Step-by-step explanation:

The most appropriate diagnostic study at this time for a 45-year-old man with symptoms suggesting acromegaly, which include an enlarged jaw, increased spaces between teeth, enlarged hands and feet, and carpal tunnel syndrome, is to measure his growth hormone levels. This condition is often caused by a growth hormone-secreting pituitary adenoma. Elevated growth hormone levels can then be confirmed with a glucose tolerance test to see if they remain high even after glucose intake, which normally suppresses growth hormone. Depending on the results, additional tests like IGF-1 levels or a CT scan of the brain might be performed to locate the adenoma.