Introduction
Mr. Elliot Bryan is a 29-year-old patient with the symptoms of enlarged feet and hands, coarse face, muscle weakness, joint stiffness, and erectile dysfunction. During his physical assessment, the signs of thyroid enlargement, high blood pressure, and hepatomegaly were revealed. Acromegaly is the primary diagnosis, but several lab tests (glucose level, complete blood count, brain MRI, and echocardiogram) are needed to clarify the situation. Evaluating personal and family history and differentiating between comorbidities are required to examine the disease and predict complications.
Patient Assessment
One of the primary issues in analyzing Mr. Bryan’s situation is attention to signs and symptoms. Symptoms are based on subjective information mentioned by the patient. In this case, they are the increased size of feet and hands, fatigue, muscle weakness, joint pain, poor vision, and depression due to erectile dysfunction. Signs are objective observations made by doctors or nurses during the assessment. Some patient signs are enlarged facial features, visible thyroid, barrel thorax, hypertension, and megaloglossia. Other important data include his family history of diabetes and hypertension.
The patient is diagnosed with acromegaly, the disorder when the pituitary gland produces extra growth hormone. Compared to gigantism, which is usually developed in childhood and provokes increased height, acromegaly occurs in adulthood and only affects the hand, feet, and facial bones. Pituitary tumors usually cause this condition, and insulin-like growth factor (IGF) 1 measurement and growth hormone (GH) measurement are necessary to confirm acromegaly (the GH level is expected to stay high after drinking glucose) (Chang et al., 2021). Magnetic resonance imaging will show the tumor’s location and size, and complete blood tests will define an overall picture of the body system. Multi-modal therapy may control acromegaly, including dopamine agonists, somatostatin receptor ligands, and other GH-receptor antagonists (Zahr & Fleseriu, 2018). Surgical removal of the tumor is another prognosis, and remission is expected if no other comorbidities affect the patient’s condition.
Muscle weakness is common in patients with acromegaly because of the inability to control decreased body fat and increased muscle mass. Regarding the patient’s characteristics (age and gender), such muscular diseases as Becker muscular dystrophy and myotonic dystrophy might develop, provoking muscle weakness and wasting in arms and legs. With age, progression is slow, and irisin secretion control is important (Mizera et al., 2021). Loss of strength and deformity are possible; thus, regular check-ups and pharmacological treatment should be followed.
Mr. Bryan is at risk of diabetes because of his family history. Besides, acromegaly is a disease characterized by type 2 diabetes as one of its possible complications. There are three diabetes types, namely 1, 2, and gestational. The last option is not appropriate for the male patient because this form is developed in pregnant females. Type 1 diabetes is a genetic condition with the first symptoms shown early. Diabetic patients of this type experience blurred vision, fatigue, hunger, and frequent urination because of the inability to protect insulin-producing cells against the immune system. Type 2 diabetes is milder than type 1 diabetes and is associated with glucose suppression and higher GH (Zahr & Fleseriu, 2018). Therefore, the patient should check his glucose level frequently to identify and predict diabetes-related complications.
Thyroid enlargement, also known as goiter, is another complication of acromegaly. Sometimes, but not always, such enlargement is linked to hyperthyroidism (excessive hormone production) or hypothyroidism (limited hormone production) (Chang et al., 2021). There are also situations when the correct number of hormones is produced, and the presence of a goiter indicates the thyroid gland’s malfunctioning or abnormality. Patients are diagnosed with multiple endocrine neoplasia type-1 syndrome in rare cases due to combined parathyroid adenoma, pituitary adenoma, and neuroendocrine tumor (Chang et al., 2021). The parathyroid glands are functionally related to the thyroid glands in regulating the necessary energy components like iodine and calcium.
Finally, such rare conditions as Cushing’s disease, Cushing’s syndrome, and Addison’s disease may be associated with acromegaly due to problematic cortisol metabolism. Cushing’s syndrome should not be confused with the disease because the latter is the type of the former. Cushing’s syndrome occurs when extra cortisol is produced because of taking medications (cortisol-like glucocorticoids). Cushing’s disease is caused not by medications but by the presence of a benign tumor in the pituitary gland and adrenocorticotropic hormone production (Chang et al., 2021). Addison’s disease is opposite to Cushing’s syndrome; it is adrenal insufficiency when too little cortisol and aldosterone are produced in the adrenal glands, leading to fatigue, muscle/joint pain, depression, and sexual dysfunction. The signs of these diseases occur simultaneously with acromegaly, and doctors need to analyze all lab tests to make the right conclusion.
Conclusion
In conclusion, Mr. Bryan’s diagnosis of acromegaly is characterized by severe changes in his body system. It is not enough to take some tests and develop an effective treatment plan. Regarding the patient’s family history, this condition might provoke serious comorbidities like diabetes, Cushing’s disease, and other musculoskeletal and endocrine problems. The assessment of current signs and symptoms and the evaluation of functional relationships should help analyze the case and choose the most appropriate steps in managing acromegaly.
References
Chang, M., Yang, C., Bao, X., & Wang, R. (2021). Genetic and epigenetic causes of pituitary adenomas. Frontiers in Endocrinology, 11. Web.
Mizera, Ł., Halupczok-Żyła, J., Kolačkov, K., Zembska, A., Grzegrzółka, J., Jędrzejuk, D., Bolanowski, M., & Daroszewski, J. (2021). Myokines in acromegaly: An altered irisin profile. Frontiers in Endocrinology, 12. Web.
Zahr, R., & Fleseriu, M. (2018). Updates in diagnosis and treatment of acromegaly. European Endocrinology, 14(2), 57-61. Web.