What are the clinical features and diagnostic approach to acromegaly?

What are the clinical features and diagnostic approach to acromegaly?

• A. Enlarged hands/feet, coarse facial features, prognathism; elevated serum IGF-1; MRI shows pituitary adenoma
• B. Hypopigmented skin lesions, hyperkalemia
• C. Weight loss, hypotension
• D. Short stature

Answer: (A)

Acromegaly is caused by excess growth hormone in adulthood, leading to overgrowth of bone and soft tissue. The hallmark clinical features are enlargement of the hands and feet, coarse facial features, and jaw protrusion (prognathism), with possible thickened skin, enlarged tongue, and secondary changes such as headaches or visual field effects if the pituitary tumor is large. Diagnostically, start with a reliable screening test: serum IGF-1. IGF-1 reflects the integrated GH secretory pattern and is relatively stable, so an elevation strongly suggests GH excess. If IGF-1 is high, confirm the diagnosis with a GH suppression test after an oral glucose load; in true acromegaly, GH fails to suppress and remains elevated. Once biochemical confirmation is obtained, use MRI of the pituitary to localize an adenoma and guide management. Why the other descriptions don’t fit: they describe conditions that don’t involve the characteristic acromegaly pattern (for example, features like hypopigmented lesions with hyperkalemia point away; weight loss with hypotension suggests other endocrine crises; short stature points to childhood GH issues such as gigantism or GH deficiency rather than adult acromegaly).

Acromegaly is caused by excess growth hormone in adulthood, leading to overgrowth of bone and soft tissue. The hallmark clinical features are enlargement of the hands and feet, coarse facial features, and jaw protrusion (prognathism), with possible thickened skin, enlarged tongue, and secondary changes such as headaches or visual field effects if the pituitary tumor is large.

Diagnostically, start with a reliable screening test: serum IGF-1. IGF-1 reflects the integrated GH secretory pattern and is relatively stable, so an elevation strongly suggests GH excess. If IGF-1 is high, confirm the diagnosis with a GH suppression test after an oral glucose load; in true acromegaly, GH fails to suppress and remains elevated. Once biochemical confirmation is obtained, use MRI of the pituitary to localize an adenoma and guide management.

Why the other descriptions don’t fit: they describe conditions that don’t involve the characteristic acromegaly pattern (for example, features like hypopigmented lesions with hyperkalemia point away; weight loss with hypotension suggests other endocrine crises; short stature points to childhood GH issues such as gigantism or GH deficiency rather than adult acromegaly).