A 52-year-old male presents with enlargement of his hands and feet which began one year ago. His jaw is also getting bigger. Acromegaly is suspected on clinical examination, and later confirmed by non-suppression of GH following a glucose load and increased serum IGF1 levels. The rest of his hormonal profile is within normal limits. MRI shows a 9 mm pituitary adenoma. The patient is advised to undergo surgery; however, he refuses adamantly because he says that he feels fine. If this patient does not get any treatment for his acromegaly, which of the following will most likely increase his mortality risk?

Question

A 52-year-old male presents with enlargement of his hands and feet which began one year ago.  His jaw is also getting bigger.  Acromegaly is suspected on clinical examination, and later confirmed by non-suppression of GH following a glucose load and increased serum IGF1 levels.  The rest of his hormonal profile is within normal limits.  MRI shows a 9 mm pituitary adenoma.  The patient is advised to undergo surgery; however, he refuses adamantly because he says that he feels fine.  If this patient does not get any treatment for his acromegaly, which of the following will most likely increase his mortality risk?

Quizplus · Accepted Answer

Explanation: Untreated cases of acromegaly have a threefold increase in mortality rate. Cardiovascular disease is the leading cause of the increased mortality rate in these patients. Approximately 50% of patients with acromegaly have hypertension. A large proportion also has LV dysfunction at the time of diagnosis. Other cardiovascular diseases in patients with acromegaly are asymmetrical septal hypertrophy, conduction defects, coronary atherosclerosis and myocardial fibrosis. Interestingly, early cardiovascular disease is reversible following successful treatment of acromegaly. Diabetes, respiratory problems, and malignancy accounts for the rest of the mortality and morbidity rates. (Choice A) Most pituitary tumors causing acromegaly show a very slow increase in their size. Rarely, acute bleeding into the tumor can lead to life-threatening pituitary apoplexy. (Choices C and D) Lung cancer and recurrent infections are not observed in patients with acromegaly. (Choice E) Patients with acromegaly have an increased risk of colon cancer. Most authorities recommend screening for colon cancer every three to five years in all patients with active acromegaly. The incidence of colonic polyps is also increased in acromegaly. Despite these facts, the risk of mortality from colon cancer and colonic polyps is much lower compared to cardiovascular mortality. Educational Objective: Patients with untreated acromegaly have an increased mortality rate mainly due to cardiovascular disease. Early cardiovascular disease in acromegaly is reversible by treatment. Patients with acromegaly also have an increased risk of colon cancer.

A 52-Year-Old Male Presents with Enlargement of His Hands and Feet