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Acromegaly — SCE Endocrinology MCQ

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EasyPituitaryAcromegalySCE Endocrinology

A 36-year-old woman has increasing ring size, sweating and headaches over 3 years. Examination shows prognathism and spade-like hands. IGF-1 is raised on two samples. What is the most appropriate next investigation?

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Correct answer: A — Oral glucose tolerance test with serial growth hormone measurement

Oral glucose tolerance test with serial growth hormone measurement is best because acromegaly is confirmed by failure of GH suppression during oral glucose tolerance testing after raised IGF-1. The alternatives are less appropriate because random GH is pulsatile; synacthen tests adrenal reserve; prolactin testing assesses lactotroph disease; dexamethasone screens for Cushing's syndrome. The SCE teaching point is to integrate the clinical pattern, biochemistry and context rather than treating an isolated result.

Reference: Society for Endocrinology acromegaly guidance