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Ectopic GHRH syndrome — SCE Endocrinology MCQ

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HardPituitaryEctopic GHRH syndromeSCE Endocrinology

A 37-year-old woman has acromegalic features, raised IGF-1 and a normal pituitary MRI. Chest CT reveals a bronchial carcinoid producing GHRH. What is the underlying pathophysiology?

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Correct answer: A — Ectopic GHRH causing pituitary somatotroph hyperplasia

Rare ectopic GHRH secretion can drive pituitary somatotroph hyperplasia and acromegaly without a pituitary adenoma. Ectopic ACTH causes Cushing's syndrome, not GH excess. The clue is acromegaly with absent pituitary lesion and a neuroendocrine tumour source.

Reference: Endocrine Society Acromegaly Guideline