With respect to the images depicted below:
Give the diagnosis. (10% marks)
List three associated biochemical abnormalities. (30% marks)
a)
Acromegaly
b)
Hyperglycaemia (Diabetes mellitus)
Hypercalcaemia
Hypercalciuria
Low cortisol
Hypernatraemia (diabetes insipidus)
Now, I don't want to get into any sort of legal trouble by reproducing the images which the college decided to withhold as a part of their "official" papers, but reliable sources report that the images used in this question were ripped straight from Wikipedia. Instead of re-using these images (which would arguably be completely legitimate, as they are covered by essentially the same Creative Commons license as the rest of this site) I have sourced others. In case one requires the college originals, they can be viewed in Chanson et al (2008).
The images I have used came from this weird alterna-health website where annoying popups tried to warn me about "Never Eat These Three Fatigue-Causing Foods" etc. Clearly these authors are not the original source of the photographic progression of male faces, which demonstrate the gradual changes associated with acromegaly. The hand pictures came from another severely ad-polluted site (Medindia.com). I hope these are unequivocal. No other answer should be possible for a).
b) affords more variation. Acromegaly is associated with a whole host of clinical features, of which biochemical abnormalities are only one part. Molitch (1992) lists a whole lot of these, but the article is paywalled. Instead one can get Melmed Shlomo's 2006 NEJM piece from tripod.com. It's just as good. In fact there is a table (Table 1, Clinical Features orf Acromegaly) which lists everything you could ever think of which might be associated witht his disease, from the local effects of pituitary adenoma to things like narcolepsy and galactorrhoea. The whole table is reproduced here.
Pituitary tumour effect |
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Skeletal effects |
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Muscular effects |
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Cutaenous manifestations |
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Airway consequences |
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Respiratory effects |
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Cardiovascular effects |
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Electrolyte, endocrine and metabolic abnormalities |
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Renal problems |
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Haematological problems |
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Philippe Chanson and Sylvie Salenave - Acromegaly. Orphanet Journal of Rare Diseases 2008, 3:17. doi:10.1186/1750-1172-3-17
Molitch, M. E. "Clinical manifestations of acromegaly." Endocrinology and metabolism clinics of North America 21.3 (1992): 597-614.
Melmed, Shlomo. "Acromegaly." New England Journal of Medicine 355.24 (2006): 2558-2573.