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OVERVIEW
This page is dedicated to organizing various examples of standardized exam questions whose answer is acromegaly. While this may seem a odd practice, it is useful to see multiple examples of how acromegaly will be characterized on standardized exams (namely the boards and the shelf exams). This page is not meant to be used as a tradition question bank (as all of the answers will be the same), however seeing the classic “test” characterization for a disease is quite valuable.
KEY CHARACTERISTICS OF THIS CONDITION (ON EXAMS)
When it comes to standardized exams, each condition has its own “code” marked by key buzzwords, lab findings, clues, etc. If you are well versed in this code you will be able to more quickly identify the condition that is being discussed, and get the right answer on the exam you are taking. Below is the “code” for acromegaly.
- Increase in size: patients may have weight gain
- Enlarged facial features: the nose, jaw, and/or tongue may get larger over time
- “Coarsening” of facial features is a popular buzzword for this condition.
- Headache may occur in patients who have a pituitary adenoma causing this condition
- Presence of pituitary mass may be seen on imaging (such as an MRI)
- Increased IGF-1 in the serum is a give-away.
QUESTION EXAMPLES
Question # 1
A 55 year old man comes to the clinic because he has been experiencing a headache for the past week. He has gained about 20lbs since his last visit about 4 months ago. His dentist has also explained that the space between his teeth are increasing. The patient has begun snoring, and has noticed that his voice has deepened over the past 6 months. A physical exam reveals frontal bossing, and the physician remarks that the patient appears to have larger facial features compared to before. What is a possible diagnosis?
Explanation # 1
Enlarging facial features + headache = acromegaly
Question # 2
A 38 year old male comes to the clinic because he has noticed that his face has been changing for the past 4 years. He complains that his nose has been getting bigger and his facial features are more “coarse” now compared to before. He also complains of muscle weakness and an increase in the size of both his hands and feet. A physical exam reveals a large and fleshy nose and a large tongue. Labs are drawn and show an increased level of IGF-1 in his serum. An MRI also reveals the presence of a pituitary adenoma. What is this patient suffering from?
Explanation # 2
Coarsening of facial features + increased IGF-1 in serum + pituitary adenoma = acromegaly
Question # 3
Explanation # 3
TESTABLE FACTS ABOUT THIS CONDITION (BEYOND ITS IDENTIFICATION)
Many questions on standardized exams go beyond simply recognizing the underlying condition. Often there are specific testable facts regarding some aspect of the disease’s pathophysiology/management/clinical implications that are commonly asked. Some of these are listed below:
- Cause: pituitary adenoma
- What does it release? Growth hormone
- How do we treat it?
- Pituitary adenoma resection is typically the first line therapy that is used.
- Somatostatin analogs (octreotide): these work to decrease levels of GH and TSH, and can be used in patients that are not able to be cured by surgery.
Page Updated: 01.22.2017