Tutorial 1: Case history

Question 1

58 yr old woman has acromegaly due to GH secreting pituitary tumour. What symptoms would you expect to see?

Answer 1

Big hands/feet - course features
Headaches
Excess sweating

Question 2

Oral glucose tolerance test was carried out. Glucose levels are high initially and stays high afterwards. What does this indicate?

Answer 2

Diabetes Mellitus

Question 3

Perimetry showed disturbance in visual field. Why?

Answer 3

Pituitary tumour compressing the optic chiasm

Question 4

Urinalysis showed glucose present in urine. Why?

Answer 4

Increase GH mobilises glucose into blood and causes excess blood sugar. Body would increase glucose excretion.

Question 5

What other investigations can be performed?

Answer 5

Test for other AP hormones

Check serum IGF1 levels

Question 6

How would you treat this patient?

Answer 6

Surgery - remove pituitary tumour.
Afterwards check hormone levels and give appropriate hormone replacement therapy.
Example: somatostatin analogue