Ancylostoma
Forum Guru
Topics: 42
Posts: 642
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During routine physical examination, a physician asks a 42 year old man to open his his mouth and say "ah". He notices that mans tongue appears larges and has deep furrow in it. The finding suggests which of the following endocrine disorders?
A acromegaly
B Addison's disease
C Cushing syndrome
D Hyperthyroidism
E Hypothyroidism
Everytime I do a block of questions I have decided to post one up for you guys. When you answer , give an explanation.
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| Palaniappan
Forum Senior
Topics: 30
Posts: 148
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Hypothyroidism....Macroglossia with a fissured tongue???
Acromegaly -I am not sure whether fissure will occur or nor..Moreover ,other features must be specified...
So ,I go with E..
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| Ancylostoma
Forum Guru
Topics: 42
Posts: 642
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I waiting for more replies before I let out the answer, come on people !!! Give it a try!!
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| drplacebo
Forum Senior
Topics: 6
Posts: 141
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Deep furrow maybe more likely 2 be relatd 2 thyroid
E seems 2 be most appropriate...
maybe fissuring is due to hypofunctioning of salivary glands....!!
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nothing in this world thats worth having,comes easy!!!- "SCRUBS"
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| babydoc4usmle
Forum Guru
Topics: 18
Posts: 634
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acromegaly causes macroglossia
i stick with A
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| MRMAVERICK
Forum Guru
Topics: 42
Posts: 749
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ankylo wats answe
boh acromegaly and hypothyorid cause macroglossia
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| Luckyall
Forum Guru
Topics: 11
Posts: 593
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Acromegaly --> macroglossia
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| Luckyall
Forum Guru
Topics: 11
Posts: 593
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And one more Qs, Ancylostoma, what source of Qs do you use at this time in your prep ?
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| me007
Forum Guru
Topics: 72
Posts: 803
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hypothyroidism is more likely.
acromegaly - increased lateral bone growth and cardiomyopathy, Goljan's book says nothing about macroglossia in this case.
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| Luckyall
Forum Guru
Topics: 11
Posts: 593
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And as an explan...i think is Acromegaly the one goes with incr. lateral bone growth( hands, feet, jaw), prominent jaw, space btw teeth, frontal bossing& MACROglossia& organomegaly
Hypothyr.--> weight gain, dry& brittle hair, periorbital puffiness, particularly around the eyes( this might be the TRICK, b/c it might have the student thinking there is also macroglossia) myxedema, mental slowness.
Now, im really curious abt answer
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| Ancylostoma
Forum Guru
Topics: 42
Posts: 642
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answer a
wow, at first no one answered and then we got multiple. I wish this would happen on every question. So the answer is that you guys are all right. Hypothyroidism and acromegaly both cause macroglossia. The key to this question was the fissured tongue. Acromegaly is very hard diagnosis in real life and thus its important to know the specific symptoms that are not found in the other endocrine disorders. They include : A large furrowed tongue, deep cracky voice, excessive perspiration, peripheral neuropathy and headache as well as all the symptoms that Luckyall described.
Noone new the actual reason (not me either), but the question was atypical and I thought it would contribute to the learning experience. I suggest that we all do this more often when we find questions that are little "out of the box".
Luck yall- I'm in the middle of finishing kaplan questions and usmle world. This was a kaplan question.
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| Luckyall
Forum Guru
Topics: 11
Posts: 593
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Thas wht i have :
Symptoms due to excess of GH/IGF-I
Soft tissue swelling and enlargement of extremities
Increase in ring and/or shoe size
Hyperhidrosis
Coarsening of facial features
Prognathism
Macroglossia
Arthritis
Increased incidence of obstructive sleep apnea
Increased incidence of glucose intolerance or frank diabetes mellitus, hypertension, and cardiovascular disease
Hyperphosphatemia, hypercalcuria, and hypertriglyceridemia may be present.
Increased incidence of congestive heart failure might be due to uncontrolled hypertension or to an intrinsic form of cardiomyopathy attributable to excess GH/IGF-I.
Increased incidence of colonic polyps and adenocarcinoma of the colon
Physical
Typical facies of acromegaly
Frontal bossing
Thickening of the nose
Macroglossia
Prognathism
Women can have mild hirsutism.
The thyroid gland might be enlarged and typically manifests as multinodular goiter.
Enlarged extremities with sausage-shaped fingers are signs of acromegaly.
Skin is oily and has skin tags. Skin tags are possible markers for colonic polyps.
Causes
Acromegaly can be either GHRH independent or GHRH dependent. Both forms cause identical clinical syndromes.
Most cases are GHRH independent. Elevated GH concentration suppresses GHRH production by the hypothalamus.
More than 95% of the GHRH-independent cases are due to a GH-secreting pituitary tumor. The pituitary adenoma might be a macroadenoma (>1 cm) or a microadenoma (<1 cm). Macroadenomas account for 80% of tumors; microadenomas account for the remaining 20%. Histopathologically, tumors include acidophil adenomas, densely granulated GH adenomas, sparsely granulated GH adenomas, somatomammotropic adenomas, and plurihormonal adenomas.
In rare cases, GHRH-independent acromegaly may result from an ectopic pituitary tumor or ectopic production of GH by other tumors (eg, cancers of the pancreas or lung).
In GHRH-dependent cases, GHRH stimulates the somatotrophs of the anterior pituitary, leading to hyperplasia and increased GH secretion. GHRH-dependent acromegaly can be caused by eutopic production of GHRH by a hypothalamic tumor or by ectopic production of GHRH by tumors such as those of the pancreas, kidneys, or lungs.
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| Ancylostoma
Forum Guru
Topics: 42
Posts: 642
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Theres no mention of furrowed tongue ?
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| Luckyall
Forum Guru
Topics: 11
Posts: 593
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No, havent seen this "forrowed tongue" mentioned ...mmmm, one reason to give full attention to kaplan Q bank ... actually i checked Robbins to see if is mentioned there, nope, not even there...
Just one double check.. is this a Kaplan Q bank Q ?
Thanks !
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| Ancylostoma
Forum Guru
Topics: 42
Posts: 642
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Yeah, it was kaplan q bank. Thats why I would trust it.
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| Luckyall
Forum Guru
Topics: 11
Posts: 593
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Thanks for posting the Qs... its an eye opener  on Kaplan Q bank
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