Page 1 of 1: medicine: acromegaly

anavrin_kaerf · Credits: 4038 My Scrapbook

confirmatory investigation for acromegaly?
-insulin induced hypoglycaemia test
-GH assay
-ACTH infusion test
-IGF levels
WHATS THE ANSWER??ON PAGE 2090 Harrison says that diagnosis is confirmed by failure of suppression of GH by 75g glucose??
So what should be the answer?answer given is GH assay!

drjanak · Credits: 1569 My Scrapbook

Davidsons 20th Ed, page 793
Growth hormone is secreted in a pulsatile fashion.A high random level does not confirm acromegaly; the diagnosis is only confirmed by failure of growth hormone to be suppressed (by the insulin-induced rise in insulin-like growth factor-1)

Page 783 20.41 ACTH STIMULATION TEST
Uses 1)Diagnosis of primary or secondary adrenal insufficiency 2)Assessment of hypothalamic-pituitary-adrenal axis in patients taking suppressive glucocorticoid therapy 3)Relies on ACTH-dependent adrenal atrophy in secondary adrenal insufficiency, so may not detect acute ACTH deficiency (e.g. in pituitary apoplexy

Harrisons 17th Ed
Age- and gender-matched serum IGF-I levels are elevated in acromegaly. Consequently, an IGF-I level provides a useful laboratory screening measure when clinical features raise the possibility of acromegaly. Due to the pulsatility of GH secretion, measurement of a single random GH level is not useful for the diagnosis or exclusion of acromegaly and does not correlate with disease severity. The diagnosis of acromegaly is confirmed by demonstrating the failure of GH suppression to <1 g/L within 1–2 h of an oral glucose load (75 g). Using newer ultrasensitive GH assays, normal nadir GH levels are even lower (<0.05 g/L).

hence confirmatory investigation should be GH suppression with oral 75 g glucose load and not GH assay

anavrin_kaerf · Credits: 4038 My Scrapbook

but answer given is GH assay!in amit ashish...u mean its wrong?ok..

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