Medical Question of the Day- 24

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

Drawing is done and the winner is Dr Sania. A copy of the book had been sent to your email

Thank you all and have a good luck on tomorrow’s Medical Questions of the Day.

19 thoughts on “Medical Question of the Day- 24”

  1. Thank you Dr Abdullahi. I hope you enjoy my questions.

  2. Very educative and beneficial thank you Dr.

  3. This Page is very appreciated thank you for this

  4. Thank you Dr Nazmul

  5. Thank you Dr Sania

  6. Thank you Dr Usman

  7. Thank you Dr Dimindra

  8. Thank you Dr Nagwa

  9. the answer is A – Assessment of insulin-like growth factor 1 (IGF-1)

    thanks dr ray for your effort

  10. Answer b

  11. Answer is option A(measurement of IGF_1)

  12. A – Assessment of IGF-1

  13. Thank you Osama Gabr. I will post the correct answer and explanation tomorrow.

  14. Thank you Dr. Rooh ullah. I will post the correct answer and explanation tomorrow.

  15. Thank you Reem. I will post the correct answer and explanation tomorrow.

  16. Correct answer is “A”
    Due to growth hormone deficiency

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