Mr. Bryan, a 29 years old married man reported the following symptoms; the progressive increase of his shoe size, enlarged fingers, coarse face, fatigue, muscles weakness, joints stiffness, depression, erectile dysfunction and loss of vision. Physical examination showed signs of enlarged and coarse facial features, prominent gradual bone changes, enlarged nose and brow, protruding lower jaw, visible and palpable thyroid, broad deep chest, enlarged liver and spleen, thick oily skin, skin lesions all over the body, blood pressure at 150/100, radial pulse at 72, large tongue and widely spaced teeth (Katznelson et al , 2014). Tests results will indicate need for further evaluation, deficient or excess growth hormone, pituitary function, acromegaly screening, diabetes, brain structure, the cause of abdominal pain or swelling, damaged heart valves, high blood pressure, or heart enlargement.
Besides a family history of diabetes mellitus, Mr. Bryan is at risk as he has benign skin lesions linked with type II diabetes mellitus, found in obese adults with high blood pressure (Vasan et al , 2001). Type I diabetes begins in childhood and patients require insulin to sustain life. Acromegaly is caused by a non-cancerous tumor commonly affecting middle-aged adults. Drugs can reduce growth hormone effects, however; surgical remissions are used to remove tumor cells. Acromegaly is common in adulthood while Gigantism is a childhood disorder (Trivellin et al , 2014). Osteoarthritis and rheumatoid arthritis are common muscular diseases caused by joint inflammation presenting pain, swelling, stiffness, reduced motion and redness. Treatments aim to reduce symptoms. Goiter is an enlargement of the thyroid gland and a swelling occurs on the neck in hypothyroidism and hyperthyroidism. Both thyroid and parathyroid glands release hormones to the endocrine body system (Farling, 2000). Cushing's disease and acromegaly are linked with the pituitary gland. Benign pituitary gland tumor causes Cushing disease and its signs and symptoms are referred to as Cushing syndrome (Laws et al , 2017).
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References
Farling, P. A. (2000). Thyroid disease. British Journal of Anaesthesia , 85 (1), 15-28.
Katznelson, L., Laws Jr, E. R., Melmed, S., Molitch, M. E., Murad, M. H., Utz, A., & Wass, J. A. (2014). Acromegaly: an endocrine society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism , 99 (11), 3933-3951.
Laws, E. R., & Jane, J. A. (2017). Surgical Treatment of Cushing’s Disease. In Cushing's Disease (pp. 91-102).
Trivellin, G., Daly, A. F., Faucz, F. R., Yuan, B., Rostomyan, L., Larco, D. O., ... & Castermans, E. (2014). Gigantism and acromegaly due to Xq26 microduplications and GPR101 mutation. New England Journal of Medicine , 371 (25), 2363-2374.
Vasan, R. S., Larson, M. G., Leip, E. P., Evans, J. C., O'donnell, C. J., Kannel, W. B., & Levy, D. (2001). Impact of high-normal blood pressure on the risk of cardiovascular disease. New England journal of medicine , 345 (18), 1291-1297.
