cooldudemle
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A 56-year-old man who underwent bilateral carpal tunnel release was found on preoperative evaluation to have new-onset diabetes mellitus and is referred by his surgeon for medical evaluation. His medical history includes hypertension and recent polyuria, nocturia, headaches, excessive diaphoresis, and joint pain. On questioning, he mentions an increase in his shoe size; he does not wear rings. He has a 6-month history of impotence, which he attributes to a change in medications for hypertension. On physical examination, he has coarse facial features, numerous skin tags, and fleshy hands.
The best next step in the management of this patient is:
(A) Measure 8 am fasting serum growth hormone.
(B) Perform insulin tolerance test with measurement of growth hormone at 0, 30, 60 min.
(C) Measure serum insulin-like growth factor 1 (somatomedin C).
(D) Measure serum insulin-like growth factor 1 following administration of 1 mg of dexamethasone at midnight
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| DrS
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? (C) Measure serum insulin-like growth factor 1 (somatomedin C).
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| cooldudemle
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Thank you Drs for ur prompt reply...what i actually wanted to know is that given a choice between measuring IGF-1 or oral glucose supression test and measuring GH subsequently
which is the best initial step and which is the better step
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| cooldudemle
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| | 12/21/05 - 07:52 AM
1 of 1 forum leaders found this post helpful
| #4 |
Thank you Drs for ur prompt reply.. .what i actually wanted to know is that given a choice between measuring A)IGF-1 or
B)oral glucose supression test and measuring GH subsequently
which is the best initial step and which is the better investigation of the two
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| DrS
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Well I believe the glucose suppression test is the gold standard test to diagnose acromegaly. But if i remember correctly IGF levels can be done initially and if they are high this confirms a diagnosis of acromegaly however normal levels do not exclude the diagnosis. And in this situation if acromegaly is suspected a glucose suppression test is done which is the most sensitive and specific test for diagnosing acromegaly. So probably the best initial step is measurement of IGF-1.
But as I mentioned earlier this info has been quoted from my memory which might not be the most reliable source. Maybe someone else can provide some insight regarding this issue
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| DrS
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Just came across something which might be of interest;
http://www.findarticles.com/p/articles/mi_m3225/i...
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| cooldudemle
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Thanks that was a great reference
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