A 54-year-old man comes to the physician because of headaches, fatigue, and joint pains involving both his wrists and knees. His wife has noticed that he has been snoring excessively at night. He has been healthy all his life and takes no medications. He has not seen a physician for more than 5 years. He denies tobacco or alcohol use. Family history is not significant.
His blood pressure is 146/70 mm Hg and pulse is 70/min. Body mass index (BMI) is 28 kg/m². Physical examination shows numerous skin tags, widened interdental spaces, and large hands. Visual fields are normal on confrontation.
Laboratory results are as follows:

The patient is at the highest risk of developing which of the following conditions if left untreated?

Question

A 54-year-old man comes to the physician because of headaches, fatigue, and joint pains involving both his wrists and knees. His wife has noticed that he has been snoring excessively at night. He has been healthy all his life and takes no medications. He has not seen a physician for more than 5 years. He denies tobacco or alcohol use. Family history is not significant.
His blood pressure is 146/70 mm Hg and pulse is 70/min. Body mass index (BMI) is 28 kg/m². Physical examination shows numerous skin tags, widened interdental spaces, and large hands. Visual fields are normal on confrontation.
Laboratory results are as follows:

The patient is at the highest risk of developing which of the following conditions if left untreated?

Quizplus · Accepted Answer

11ec193a_97a8_9c9c_853d_4d1aad74e6e3_MD0002_00 This patient's presentation is consistent with acromegaly based on the clinical symptoms (summarized in the above table) and elevated IGF-1 levels. Acromegaly is associated with an increased risk of cancer (e.g., colon, esophageal, gastric, and melanoma), likely due to IGF-1 stimulating mucosal cell proliferation. The mortality rate from colon cancer is also higher in acromegaly patients compared to the general population. Acromegaly increases the risk of developing adenomatous colonic polyps, especially in patients with a family history of colon cancer, age > 50, male sex, longer duration of acromegaly, and > 3 skin tags. Screening colonoscopy is recommended in acromegaly patients at the time of diagnosis and every 3-4 years after age 50. Untreated acromegaly also has a higher mortality, usually due to cardiovascular disease and cancer. (Choice A) Cardiovascular complications of acromegaly include concentric hypertrophy of the myocardium with diastolic dysfunction, congestive heart failure, and hypertension. Ascending aortic aneurysms are usually not associated with acromegaly, but they are associated with other conditions (e.g., giant cell arteritis, Marfan syndrome, Ehlers-Danlos) that require routine screening. (Choice C) Hyperphosphatemia is seen in up to 70% of acromegaly patients, likely due to IGF-1 stimulation of renal tubular phosphate reabsorption. Hypophosphatemic osteomalacia is more commonly seen in vitamin D deficiency, mesenchymal tumors, and Fanconi syndrome. (Choice D) Growth hormone receptors are abundant in the liver, and high GH from acromegaly can cause liver enlargement. However, it does not usually increase liver fibrosis leading to cirrhosis. (Choice E) Acromegaly increases the incidence of sleep apnea (central and obstructive) and narcolepsy, but it is not associated with an increased risk of emphysema. Educational objective: Acromegaly is associated with an increased risk of esophageal cancer, gastric cancer, colon cancer, and melanoma. Screening colonoscopy is recommended at the time of diagnosis and every 3-4 years after age 50. The mortality of untreated acromegaly is higher than the general population, usually due to cardiovascular disease and cancer. __________ References: Oncological complications of excess GH in acromegaly (http://www.ncbi.nlm.nih.gov/pubmed/12638722) Risk of colorectal neoplasm in patients with acromegaly: a meta-analysis. (http://www.ncbi.nlm.nih.gov/pubmed/18567075)

A 54-Year-Old Man Comes to the Physician Because of Headaches