Thank you for the great response for the 1st Quiz.
Here comes the quiz for Station 5.
The diagnosis is rather clear cut but how do we get 4/4 instead of 3/3 ??
This patient has acromegaly and the disease is inactive, currently complicated by bilateral carpal tunnel syndrome and urinary tract infection
Examination of the hands reveals large spade like hand. It is however not sweaty or warm. Positive Tinel sign suggestive of bilateral carpal tunnel syndrome.
There is no proximal muscle weakness
There is prominent supraorbital ridge with prognathism and large nose and large tongue. There is also interdental separation.
There is no visual field defect and no goiter.
There is heel pad thickening
I would also like to check the BP, urine dipstick for glycosuria, organomegaly and the old photograph of this pt.
There are several other signs which are not listed here which may need to be checked. Please identify and tell so that one can score 4/4 !
Any takers ?
The diagnosis is rather clear cut but how do we get 4/4 instead of 3/3 ??
This patient has acromegaly and the disease is inactive, currently complicated by bilateral carpal tunnel syndrome and urinary tract infection
Examination of the hands reveals large spade like hand. It is however not sweaty or warm. Positive Tinel sign suggestive of bilateral carpal tunnel syndrome.
There is no proximal muscle weakness
There is prominent supraorbital ridge with prognathism and large nose and large tongue. There is also interdental separation.
There is no visual field defect and no goiter.
There is heel pad thickening
I would also like to check the BP, urine dipstick for glycosuria, organomegaly and the old photograph of this pt.
There are several other signs which are not listed here which may need to be checked. Please identify and tell so that one can score 4/4 !
Any takers ?
Pictures and case contributed by Wuchereria.
Look for osteoarthritis (joint crepitation, pain, swelling, reduced range of motion) Also check for skin tag, rectal polyps, galactorea.
ReplyDeleteIs the 2nd photo showing a urinary catheter? My monitor a bit blurry. Hmm..Why is he on the catheter?
The urine is cloudy. Any idea?
ReplyDeleteUrine is cloudy?Well, you mentioned that he had an UTI
ReplyDeleteOther signs to check for: CVS system looking for displaced apex and possibly systolic murmur due to hyperdynamic circulation
Anything else ? I challenge axonopathic to give the answer !!
ReplyDeletexiao zhai ..... good response !
ReplyDeleteTo my dear buddy, wuchereria
ReplyDeleteAha..a challenge huh?
Good!
Ok, I think this patient has acromegaly, disease activity currently quiescent. He most probably has prostatomegaly as part of his visceromegaly, thus causing urinary retention needing an indwelling catheter/ intermittent catheterisation. I would be keen to do a per rectal examination to confirm an enlarged prostate. I would examine the abdomen to look for other associated organomegaly as well.
Alternatively as a differential, he might have a vertebral fracture due to osteoporosis with spinal cord compression, thus resulting in neurogenic bladder needing an indwelling catheter. (In real-life PACES, offer to examine the back for step deformity and examine the lower limbs neurologically)
As the urine is cloudy, I would treat him empirically for UTI and change his catheter promptly. His catheter tip is to be sent for C&S.
Should be 4/4
ReplyDeleteWuchereria, anything to add:)
Prostatic Hyperplasia: An Unknown Feature of Acromegaly
ReplyDeleteIn acromegaly, everything becomes bigger except one thing. What is it ?
ReplyDeleteThe eyes
ReplyDeleteNot really
ReplyDeleteVery good comments,so far
ReplyDeletebut !! Why do we still review pts with acromegaly even though we have treated the disease and its quiescent as in our pt?
Even after successful surgery and normalization of hormone levels, patients should be monitored closely for possible recurrence, even years after the surgery.
ReplyDeleteMore commonly, hormone levels will improve, but they may not return to normal. Additional treatment, usually with drug therapy, may be required.
Testes may be small in Acromegalic patients.
ReplyDeleteCheers.
MK32.
Yep MK32, you got it!
ReplyDeleteIn fact it's a trick question from Wuchereria ;)
Thanks for the great answers guys! Can I ask why do acromegalic patients get osteoporosis?
ReplyDeletethe reason for osteoporosis in acromegaly is due to hypogonadotrophic hypogonadism secondary to underlying pituitary macroadenoma. It is also the cause for testicular atrophy
ReplyDeletetestes small and osteoporosis , great co-relation.thanks
ReplyDeletethe other features of acromegaly :
ReplyDeleteLVH and heart failure, osteoarthritis, acnthosis negrans,