A 54-year-old woman with a 6-year history of type 2 diabetes visits her physician for a regular examination. She was initially treated with oral hypoglycemic but her HbA1c had gotten worse so, her physician switched to insulin last year. Six-month ago, she had surgery in her wrist to release compression caused by carpal tunnel syndrome. Now, she complains of progressive increase in her feet size. Examination reveals coarse facial features with prominent supraorbital ridge.
What is the most appropriate test to help reach the diagnosis of this case?
A – Assessment of insulin-like growth factor 1 (IGF-1)
B – Measurement of thyroid stimulating hormone (TSH)
C – Measurement of HbA1c
D – Fasting serum glucose test
E – Dexamethasone suppression test
This is a case of acromegaly due to increased secretion of growth hormone. Insulin-like growth factor 1 is secreted by the liver in response to high level of growth hormone. High levels of IGF-1 support the diagnosis of acromegaly. CT scan of the head and/or MRI of the brain should follow to find the cause which could be pituitary adenoma or hyperplasia. Fasting serum glucose test and HbA1c should be done routinely but they have no rule in diagnosis of the new condition. There is no clue for thyroid or adrenal gland involvement in this case so other choices are incorrect.
The correct answer is A
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