iatroX Rounds #12

The clues

1. 1

   A 52-year-old man presents to his GP complaining of persistent lethargy and generalized joint pains that have worsened over the last two years.

2. 2

   He mentions that his wedding ring has become too tight to remove and he recently had to purchase new shoes in a larger size.

3. 3

   His partner reports that he snores loudly at night and he often feels excessively sleepy during the daytime.

4. 4

   Physical examination reveals a prominent supraorbital ridge, macroglossia, and wide, spade-like hands with doughy palms.

5. 5

   Initial biochemical investigations show an elevated age-standardized serum insulin-like growth factor-1 and a new diagnosis of diabetes mellitus.

6. 6

   Definitive testing demonstrates a failure to suppress serum growth hormone levels to less than 1 microgram/L following a 75g oral glucose load.

for education and entertainment. not medical advice.