Name: Mr. Elliot Bryan
Age: 29 years old
Mr. Bryan is a 29-year-old married man who came to the medical office because, over the last three years, he has progressively increased the size of his shoes, and he has resized his wedding ring three times. He says his feet and hands have grown. He has also noticed that his face has turned coarse. He was a very active man and practiced sports, but now he fatigues just by walking, and feels weakness in his muscles and stiffness in his joints. He is depressed because in the last few months he has been experiencing erectile dysfunction, which is affecting his relationship with his wife. He feels he is losing his vision as well.
Mr. Bryan does not drink alcohol, smoke, or use any recreational drug. His mother suffers from diabetes mellitus type II, and his father suffers from hypertension.
On physical examination we found:
Remarkable Signs on Physical Exam by Regions
Head: Enlarged and coarsened facial features, prominent superciliary arches, prognathism
Neck: Thyroid is visible and palpable
Thorax: Barrel appearance
Abdomen: Hepatomegaly. Splenomegaly.
SOMA: Enlargement of the hands and feet. Generalized arthralgia.
Remarkable Signs on Physical Exam by Systems
Integumentary system: Thick and oily skin. Numerous acrochorda disseminated throughout the body.
Cardiovascular system: Blood pressure 150/100. Radial pulse 72.
Digestive system: Megaloglossia. Diastema.
Complete blood count (CBC)
Growth hormone suppression test
Abdominal CT scan
In at least 750 words, or 2 double-spaced pages, prepare a case report that addresses the following:
1. Based on the case study provided, respond to the following questions:
o Identify and differentiate the symptoms from the signs in this patient.
o Is there any remarkable personal, social, and/or family history?
o What results do you expect to find in the tests ordered?
o What is the etiology of acromegaly? What is the prognosis?
o How can you differentiate acromegaly from gigantism?
2. The patient refers to muscle weakness. Mention some common muscular diseases, and explain them briefly, including their prognoses.
3. Is Mr. Bryan at risk of suffering from diabetes mellitus? Why? How many types of diabetes mellitus are there? What are the differences between them?
4. Normally, the thyroid is not visible or palpable. What is the medical term for thyroid enlargement? Is thyroid enlargement always linked to a hyperthyroidism or a hypothyroidism? What is the functional relationship of the thyroid with the parathyroid?
5. Is it common to see Cushing’s disease associated with acromegaly? What is the difference between Cushing’s disease and Cushing’s syndrome? What is Addison’s disease?
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