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Robbins and Cotran Pathology-Endocrine

Terms in this set (66)

B Failure of growth hormone suppression
Failure to suppress growth hormone (GH) levels by glucose infusion suggests autonomous GH production. The patient's symptoms suggest acromegaly, and a GH-secreting adenoma is most likely. Acromegaly causes an overall increase in soft tissue in adults because of the anabolic effects of the increase in GH. Because the epiphyses of the long bones are closed in adults, there is not the increase in height, or gigantism, that would be seen in children with a pituitary adenoma that is secreting excessive GH. Instead, the increase in soft tissue mass manifests as increasing shoe or glove size, carpal tunnel syndrome, and coarse facial features. This woman probably has an abnormal glucose tolerance test result, but this does not indicate the underlying cause of diabetes mellitus, which in this case is secondary to acromegaly. A prolactinoma would cause amenorrhea and galactorrhea in a woman. A thyroid-stimulating hormone (TSH)−secreting adenoma of the pituitary can give rise to hyperthyroidism with an increased metabolic rate that would most likely to lead to weight loss, and glucose intolerance is not a feature of hyperthyroidism. Functional pituitary tumors can be detected clinically before they become large enough to cause pressure symptoms such as visual disturbances. Cushing syndrome from an adrenal cortical neoplasm producing cortisol could be accompanied by glucose intolerance, hypertension, and truncal obesity, but there is no overall increase in soft tissues.