Based on the case study provided, respond to the following questions: Identify a

Question

Based on the case study provided, respond to the following questions:

Identify and differentiate the symptoms from the signs in this patient.

Is there any remarkable personal, social, and/or family history?

What results do you expect to find in the tests ordered?

What is the etiology of acromegaly? What is the prognosis?

How can you differentiate acromegaly from gigantism?

Personal Information

Name: Mr. Elliot Bryan

Age: 29 years old

Gender: Male

Description

Mr. Bryan is a 29-year-old married man who came to the medical office because, over the last three years, he has progressively increased the size of his shoes, and he has resized his wedding ring three times. He says his feet and hands have grown. He has also noticed that his face has turned coarse. He was a very active man and practiced sports, but now he fatigues just by walking, and feels weakness in his muscles and stiffness in his joints. He is depressed because in the last few months he has been experiencing erectile dysfunction, which is affecting his relationship with his wife. He feels he is losing his vision as well.

Mr. Bryan does not drink alcohol, smoke, or use any recreational drug. His mother suffers from diabetes mellitus type II, and his father suffers from hypertension.

On physical examination we found:

Remarkable Signs on Physical Exam by Regions

Head: Enlarged and coarsened facial features, prominent superciliary arches, prognathism

Neck: Thyroid is visible and palpable

Thorax: Barrel appearance

Abdomen: Hepatomegaly. Splenomegaly.

SOMA: Enlargement of the hands and feet. Generalized arthralgia.

Remarkable Signs on Physical Exam by Systems

Integumentary system: Thick and oily skin. Numerous acrochorda disseminated throughout the body.

Cardiovascular system: Blood pressure 150/100. Radial pulse 72.

Digestive system: Megaloglossia. Diastema.

Lab Tests

Complete blood count (CBC)

GH measurement

IGF-I measurement

Growth hormone suppression test

Glucose level

Brain MRI

Abdominal CT scan

Echocardiogram

Diagnosis

Acromegaly

Explanation / Answer

Acromegaly:
signs and symptoms:bryan signs and symptoms similar with actual symptoms are
-enlarged bones in the face,feet and hands
-high blood pressure
-Swallon and painful joints that limit movement..this symptoms present for bryan so he feels fatigue,feels weakness in his muscles and stiffness in his joints..
-erectile dydfunction in men
-Lower sex drive
-Muscle weakness
-Profuse sweating
-enlarged sebaceous glands,which are glands that produce oils in the skin..numerous acrochorda disseminated through out the body..
-Hoarser voice and deeper
Common symptoms like in ablilty to sleep,an enlarged jaw or tongue,a prominent brow,weight gain,spalyed fingers and toes..
Remarkable history:
Familiy history he is having mother with type II diabetes and father suffered with hypertension(having hormonal dysfunction)
Personal history there will be accelerates bone growth and organ enlargement..people with acromegaly are mush larger than other people's bones and organ..Bryan having history of enlarged spllen and liver..and his thyroid is visible and palpable..Megaloglossia(enlargement of tongue is also present..
Investigation:
GH measurement:
It will flucuate through out the day,glucose tolerance test doctor may order this ..if body secreting normal level of GH,excess glucose will cause your body to suppress your GH levels..We can find high GH levels in Acromegaly..
IGF- 1(insulin -like growth factor 1) it shows if there is abnormal growth in the body..X-rays to check excess bone growth incase of acromegaly..sonomgram will help check the size of internal organs..
MRI and CT scans to help them find the pitutary tumor and detrmines the size..If they did not find any tumor doctor will look chest,abdomen or pelvis having excess GH prodection
complete blood count: Normocytic normochromic anaemia and eosinophilia may be seen with glucocorticoid deficiency..
Echo cardiogram: this is to findout the evidence of any cardiomyopathy..
Growth hormone suppress test
this is not a diagnostic test ..It will help assess response to treatement with long acting somatostatin analogues..
Etiology:
The most common cause is a pituitary adenoma,a non cancerous tumor that makes growth hormone from your pituatary gland..it is there in the skull just below the brain..it is part of the endocraine or hormone system..because of the tumor body makes too much growth hormone..
Prognosis:
surgical procedure may cause some complications..according to the size of the tumor patient respond to the treatement..80 to 85% of patient with small size tumor recover fast and large lesions in which the success rate is 50-65% untreated patients can live upto 50years..
Difference between gigantism and acromegaly:
    Gigantism occurs during childhood and acromegaly appears in adulthood..Gigantism is a rare condition can start at any age before epiphyseal fusion at puperty,symptoms like head ache,visual disturbances,obesity,joint pain and excessive sweating..but acromegaly is a common than gigantism..mortality rate higher than gigantism..gigantism features excessive tallness while acromegaly features excessive growth of the lower jaw,tongue and finger ends..

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