Question

A 42-year-old woman presents with enlarged hands, coarsened facial features, and increased shoe size. Her IGF-1 level is elevated. Which of the following is the most specific test to confirm the diagnosis?

• A. Measurement of IGF-1 alone
• B. Lack of GH suppression following oral glucose tolerance test (OGTT)
• C. Lack of IGF-1 suppression after OGTT
• D. Random growth hormone level

Hint:

Acromegaly confirmation = failure of GH suppression after oral glucose.

Answer 1

The Correct Option is B

Concept: Enlarged hands, coarse facial features, and increased shoe size suggest acromegaly. Elevated IGF-1 is a screening clue, while failure of GH suppression after oral glucose is confirmatory.

Step 1: Identify the diagnosis.
The clinical features are: \[ \text{Enlarged hands + coarse facial features + increased shoe size} \] This suggests: \[ \text{Acromegaly} \]

Step 2: Recall screening and confirmatory tests.
IGF-1 is useful for screening. The confirmatory test is: \[ \text{Oral glucose tolerance test} \]

Step 3: Interpret OGTT in acromegaly.
Normally, glucose suppresses GH. In acromegaly: \[ \text{GH fails to suppress after OGTT} \]