Underlying

Endocrine System


{"ops":[{"insert":"Clinical Reasoning"},{"insert":"\n","attributes":{"header":1}},{"insert":"Decision 1: the probable diagnosis"},{"insert":"\n","attributes":{"header":2}},{"insert":"Ivy has presented with a constellation of signs and symptoms: recent-onset generalized headaches; recently diagnosed diabetes mellitus; recent weight gain; deepening of her voice; prognathism; macroglossia; increased dental spacing; thickening of the brow ridges, nose, and ear lobes; increased terminal hair over both forearms and shins. Considered together, this is strongly suggestive of acromegaly. \n\nBoth hypothyroidism and polycystic ovarian syndrome would explain the weight gain, but not the other findings.\nDecision 2: confirming the diagnosis"},{"insert":"\n","attributes":{"header":2}},{"insert":"Where acromegaly is suspected clinically, current guidelines recommend assessing IGF-1 levels; elevated levels are strongly suggestive of acromegaly. Growth hormone (GH) suppression testing should be used to confirm acromegaly once IGF-1 levels are found to be elevated. Determination of random GH levels is not recommended routinely.\nDecision 3: choosing between medical and surgical management"}]}

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